Economic Analysis and Policy Suggestions for Prenatal Screening and Diagnosis on Down's Syndrome in China

Down Syndrome is a disease that can cause a significant economic burden on both society and individual families. It has a relatively high incidence compared to other conditions, but it can be detected with the proper use of prenatal screening and diagnostic tests. This paper conducted a cost-benefit analysis, cost-effectiveness analysis with the Incremental Cost-Effectiveness Ratio (ICER), a Criteria Importance through Intercriteria Correlation (CRITIC) model. Through using a Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) model to evaluate and compare the three different prenatal diagnostic tests for DS, amniocentesis, noninvasive prenatal testing (NIPT), and chorionic villus sampling (CVS). The result showed that amniocentesis and CVS are both cost-benefit and cost-effective, ranking the first in the CRITIC and TOPSIS models, with amniocentesis having a more significant lead. In contrast, NIPT has a negative net benefit and is not cost-effective, ranking third in both models. Amniocentesis should be compulsory in China, with the government covering $402 and individual families paying $98. Choices should be given to individual families if they are willing to pay more to take NIPT if they are worried about the risk of invasive amniocentesis. People with autoimmune diseases and other diseases that can increase the risk of miscarriage with an invasive test should be provided with NIPT with the government covering the extra fee. A selection system with the prenatal test for DS as the default choice is another option for policy implementation based on the nudge theory. This policy can release around $8,265,075,000 economic burden on the society and $1,100,000,000 on individual families annually in China, creating more economic value for the rapidly growing country.