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Table 2 Screening performance for trisomy 21 using contingent, reflex, and primary cfDNA screening strategies (assuming a screening population of 100,000 women, and eFTS used as the primary screening test for contingent and reflex cfDNA screening)

From: Prenatal screening for trisomy 21: a comparative performance and cost analysis of different screening strategies

Strategy

Contingent cfDNA screening

Reflex cfDNA screening

Primary cfDNA screening

Risk cut-off(s) of eFTS

1 in 1000

1 in 1000

1 in 1000

1 in 50 and 1 in 1000

 

cfDNA screening technology

Sequencing

Sequencing

RCA/Imaging solution

RCA/Imaging solution

Sequencing

RCA/Imaging solution

# eFTS positive

11,250

11,250

11,250

11,250 (a)

–

–

# cfDNA screening

11,250

11,250

11,250

9850

100,000

100,000

# cfDNA screening high risk

253 (b)

247 (c)

254 (c)

82 (c)

354 (b)

356 (c)

# cfDNA screening no-call result

135 (d)

371 (e)

56 (e)

49 (e)

1200 (d)

500 (e)

# patient receiving GC

11,250 (f)

618 (g)

311 (g)

1532 (h)

1554 (g)

856 (g)

# GC session

11,443 (i)

618 (g)

311 (g)

1532 (h)

1554 (g)

856 (g)

# PND (cfDNA screening high risk)

253

247

254

1482 (j)

354

356

# PND (cfDNA screening high risk/no-call)

388

618

311

1532

1554

856

# Expected T21

260

260

260

260

260

260

# T21 diagnosed through PND (cfDNA screening high risk)

242

236

243

246 (k)

254

256

# T21 diagnosed through PND (cfDNA screening high risk/no-call)

245

245

245

246

257

257

# T21 eFTS negative

13

13

13

13

–

–

# T21 cfDNA screening low risk

2

2

2

1

3

3

# T21 cfDNA screening no-call

3

8

1

0

3

1

# T21 missed by eFTS or cfDNA screening

15

15

15

14

3

3

# T21 livebirth

9

9

9

8

2

2

# Procedure related fetal loss

0

1

0

4

4

2

DR (cfDNA screening high risk)

92.2%

91.0%

93.6%

94.6%

97.7%

98.5%

FPR (cfDNA screening high risk)

0.01%

0.01%

0.01%

1.24%

0.10%

0.10%

Overall DR (all cfDNA screening no-call have a PND)

94.1%

94.1%

94.1%

94.7%

99.0%

99.0%

Overall FPR (all cfDNA screening no-call have a PND)

0.14%

0.37%

0.07%

1.29%

1.30%

0.60%

  1. Numbers of pregnancies were rounded to the nearest whole number
  2. T21 Trisomy 21, cfDNA screening cell free fetal DNA screening, eFTS Enhanced first trimester screening, RCA/Imaging solution automated high precision rolling circle amplification/Imaging solution, GC Genetic counselling, PND Prenatal diagnosis testing (Chorionic villus sampling and amniocentesis), DR Detection rate, FPR False positive rate
  3. a. Women with eFTS risk≥1/50 (1400) or risk between 1/51–1/1000 (9850); b. cfDNA screening high risk from the first and second tests; c. cfDNA screening high risk from the first test (assuming no repeat test is offered if the first test has a no-call result); d. cfDNA screening no-call result after the second test (assuming a repeat test is offered if the first test has no-call result); e: cfDNA screening no-call result after the first test; f: Women screen positive for eFTS; g: Women with cfDNA screening high risk or no-call results; h: Women with eFTS risk≥1 in 50 (1400) and women with high risk (82) or no-call cfDNA screening results (49); i: Women with positive eFTS (11,250) have a full session of GC, women with a high risk cfDNA screening (253) and no-call cfDNA screening (135) also have a follow-up 1/2 session of GC; j: Women with eFTS risk≥1 in 50 (1400) and high risk cfDNA screening (82); k: T21 diagnosed among women with eFTS risk≥1 in 50 or high risk cfDNA screening