Unjustified: The Imbalance of Information and Funding With Noninvasive Prenatal Screening

Abstract

Background: Noninvasive prenatal screening (NIPS) is the latest in prenatal testing technologies for Down syndrome and other aneuploidies. It joins existing traditional screening and invasive testing. The administration and funding of prenatal testing for aneuploidy has been the subject of several studies evaluating whether women are making informed choices and whether prenatal testing is cost-effective. Methods: A review of professional medical guidelines, studies on informed consent and cost-effectiveness, and how NIPS is currently being administered and covered by private and public insurance was conducted. Results: Since the major medical organizations have recognized NIPS, particularly for women considered high risk, NIPS is being offered to expectant mothers. Increasingly, public and private insurance are covering NIPS based on the medical guidelines, with cost-effectiveness studies justifying its coverage. The same guidelines recommend pre-test counseling and post-test counseling along with providing patient educational materials with each prenatal test result. Consistent with past practice with traditional screening and invasive testing, these patient educational resources are not being provided or covered at the same rate as the testing itself. Conclusions: The administration of prenatal testing continues to only provide one part of the information recommended by medical guidelines: the testing itself. Patients are not receiving the recommended pre- and post-test counseling and educational materials, nor are these being covered to the same extent as the cost of the NIPS test itself. Unless all of the information recommended by the medical guidelines is both provided and covered to the same extent as the testing itself, offering and covering the costs of NIPS is unjustified.