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•PND for fetal aneuploidy is the most common indication to perform invasive prenatal testing.•Data from Rajanukul institute of Thailand found that the capabilities of conventional karyotyping should not more than 20,000 cases per year. In simulation model, the laboratory personnel and genetic technician may have to analyze conventional karyotyping around 87,000 cases per year.•Traditionally, PND of chromosomal abnormality relies on conventional karyotyping method. This is a labor intensive task and took around 3-4 weeks to confirm the report.•BoBsTM (molecular karyotyping) was modified from comparative genomic hybridization by using immobilized BAC clones attached to dyed fluorescent microspheres beads.

Introduction

No conflict of interest relate to this article

Results

From the purchaser’s perspective view, the incremental benefit to incremental cost ratio when comparing KL-BoBsTM to conventional karyotyping method was 1.48.

The incremental benefit was 874 Bahts more than the incremental cost.

The WTP for faster turnaround time which would relieve the participants from anxiousness in conventional karyotyping group was the most powerful parameter using one-way sensitivity analysis.

1 Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 2 Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 3

Sector for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Wirada Dulyaphat, MD1, Chayada Tangshewinsirikul, MD1, Budsaba Rerkamnuaychoke, DM Sc2, Takol Chareonsirisuthigul, MD PhD2,

Oraluck Pattanaprateep, PhD3, Panyu Panburana, MD1

Cost-benefit Analysis of Prenatal Diagnosis by Molecular Karyotyping Versus Conventional Karyotyping for Detection of Aneuploidies in Ramathibodi Hospital

KaryoLite BACs-on BeadsTM (KL-BoBsTM) technique is

valuable in the perspective of pregnant women

undergoing amniocentesis for high risk of aneuploidy

Figure1: The principle of BoBs TM and KL-BoBsTM technique

Materials and methods

A total of 160 singleton pregnancies with obstetric indications for amniocentesis were enrolled at 16-23

weeks’ gestation. Subjects were randomly and equally allocated into 2 groups. All participants were

interviewed and completed the questionnaires. Total costs were collected. The benefit in this study was the

health state change from relieving of anxiousness described in term of willingness to pay (WTP) for faster

turnaround time in each laboratory method. The decision tree model was applied to estimate the ratio of

incremental benefit to incremental cost. One way probabilistic sensitivity analyses was applied.

*Under the assumed circumstances: singleton, maternal age 35 years or greater, turnaround time

more than 24 hours.

Figure3: The decision tree model. The first arm represented cases with reference method (conventional

karyotyping) while the second arm revealed cases with alternative method

*The cost-benefit between 2 methods was calculated by using the following equation:

∆ Benefit B2-B1 (WTP x faster-turnaround-days result expectation) ∆ Cost C2-C1 (direct medical cost + direct non medical cost + indirect cost)

Figure2: Flow chart of the population of the study

Figure 4: Incremental benefit to incremental cost ratio of the participants (∆B/∆C= 2677.5 / 1803.5 (Thai Bahts) = 1.48)

Figure 5: One-way sensitivity analysis (to determine the impact of each parameter value)G1= group 1, G2= group 2, WTP = willingness to pay, USG = ultrasonography

= =