Changes in prenatal care after the introduction of insurance coverage for noninvasive prenatal testing (NIPT) in Switzerland

Purpose: Prenatal care has been significantly influenced by the introduction of noninvasive prenatal testing (NIPT) for aneuploidies in 2012. In Switzerland starting from July 2015 the national insurance companies cover NIPT as a second line screening for women who are at an intermediate or high risk after first trimester screening (FTS). The aim of this study was to describe the changes in prenatal testing after the integration of NIPT into national health care plans.

Material and methods: Retrospective analysis including all women with singleton pregnancies who presented for FTS between July 2014 and December 2015 (n = 887). After FTS the women where categorized into three risk categories for aneuploidy: low risk (< 1:1000), intermediate risk (1:1000 – 1:100) and high risk (> 1:100). We assessed the decision on prenatal testing according to risk category. The year before, and 6 months after the introduction of insurance coverage were evaluated.

Results: 573 FTS were carried out before the introduction of insurance coverage for NIPT (group 1) and 314 after (group 2). In group 1, 9% had NIPT as compared to 22.9% in group 2. In group 2 52.3% of the high risk patients, 72.4% of women with an intermediate risk and 8.0% of the low risk patients had NIPT. The number of invasive procedures decreased by 5.7%. In group 2 81.8% of the women with a high risk who chose NIPT had a normal ultrasound exam.

Conclusions: We observed a notable increase of NIPT and a further decrease of invasive procedures after the introduction of insurance coverage for NIPT. The greatest NIPT increase was within the intermediate risk category. Invasive procedures now are mostly chosen in the presence of abnormal ultrasound findings.