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Economic Impact of Coverage Expansion for Non-invasive Prenatal Testing Through a Performance-Based Risk-Sharing

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Expanding non-invasive prenatal testing (NIPT) coverage for women under 35 increased NIPT use and decreased conventional screening methods. This led to a small rise in per member per month expenditures.

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Area of Science:

  • Genetics and Genomics
  • Maternal-Fetal Medicine
  • Health Economics

Background:

  • Non-invasive prenatal testing (NIPT) analyzes cell-free DNA for fetal aneuploidies, offering higher accuracy than traditional screening.
  • Harvard Pilgrim Health Care expanded NIPT coverage for women under 35 via a risk-sharing agreement to manage costs.

Purpose of the Study:

  • To evaluate the impact of expanded NIPT coverage on prenatal screening practices.
  • To assess changes in healthcare payer expenditures following NIPT coverage expansion.

Main Methods:

  • A real-world study compared prenatal screening and diagnostic test utilization and costs before and after NIPT coverage expansion.
  • Incidence rate ratios (IRRs) analyzed changes in screening method utilization.
  • A budget impact model estimated changes in per member per month (PMPM) expenditures.

Main Results:

  • NIPT orders increased significantly (IRR 1.41) while conventional screening decreased (IRR 0.87) post-coverage expansion.
  • Maternal age and invasive testing rates remained stable.
  • The estimated increase in PMPM expenditures was minimal ($0.026).

Conclusions:

  • Expanded NIPT coverage for women under 35 successfully increased NIPT adoption and reduced reliance on older screening methods.
  • The coverage expansion resulted in a modest financial impact on payers.