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Background: The first- and second-trimester screening for trisomy 21 (T21) are reimbursed for all pregnant women in Belgium. Using a cut-off risk of 1:300 for T21, about 5% of all pregnant women are referred for definitive prenatal diagnosis using an invasive test, at a sensitivity of (only) 72.5%. The sensitivity and specificity of the non-invasive prenatal test (NIPT) are over 99% but come at a cost of €460 (£373) per test. The objective is to estimate the consequences of introducing NIPT for the detection of T21. Methods: A cost-consequences analysis was performed presenting the impact on benefits, harms and costs. Context-specific real-world information was available to set up a model reflecting the current screening situation in Belgium. This model was used to construct the second and first line NIPT screening scenarios applying information from the literature on NIPT's test accuracy. Results: Introducing NIPT in the first or second line reduces harm by decreasing the number of procedure- related miscarriages after invasive testing. In contrast with NIPT in the second line, offering NIPT in the first line additionally will miss fewer cases of T21 due to less false-negative test results. The introduction of NIPT in the second line results in cost savings, which is not true for NIPT at the current price in the first line. If NIPT is offered to all pregnant women, the price should be lowered to about €150 to keep the screening cost per T21 diagnosis constant. Conclusions: In Belgium, the introduction and reimbursement of NIPT as a second line triage test significantly reduces procedure-related miscarriages without increasing the short-term screening costs. Offering and reimbursing NIPT in the first line to all pregnant women is preferred in the long term, as it would, in addition, miss fewer cases of T21. However, taking into account the government's limited resources for universal reimbursement, the price of NIPT should first be lowered substantially before this can be realised. [ABSTRACT FROM AUTHOR]

The article discusses the use of transcatheter aortic valve implantation (TAVI) as a form of treatment for patients with a life threatening heart condition. However, several doubts still remain with regards to the cost effectiveness and clinical outcomes of TAVI. Rigorous analysis of available data has revealed that the widespread use of TAVI is not really recommended as was observed from the PARTNER trial. The National Institute for Health and Clinical Excellence (NICE)has said that in the cases of patients for whom surgery was suitable, TAVI was inadequate and should only be used in cases where special arrangements for clinical governance, consent and data collection were present.