Cost-effectiveness of universal and contingent nipt within a multi-tariff healthcare system: A full incremental decision-analytic cohort study

Objective: To compare universal and contingent non‐invasive prenatal testing (NIPT) strategies within a multi‐tariff healthcare system using a full incremental cost‐effectiveness framework and to identify price levels at which universal NIPT becomes economically competitive with the best reflex strategy. Method: A deterministic decision‐analytic cohort model representing 1,000,000 pregnancies was developed. For each strategy, trisomy detection, false‐positive and missed cases, invasive procedures, procedure‐related fetal loss, and short‐term psycho logical quality‐adjusted life year (QALY) losses were estimated. Medical costs were derived from public, university, and private‐ sector tariffs. Incremental costs, QALY losses avoided, and cost‐effectiveness ratios were calculated across all strategies; CT‐based pairwise analyses were retained as secondary analyses. Price‐threshold analyses and probabilistic sensitivity analysis generated threshold estimates and acceptability curves. Results: Contingent NIPT strategies markedly reduced false‐positive results and invasive procedures, yielding the lowest short‐ term QALY losses. In full incremental analysis, Reflex300 was the only strategy on the frontier in private‐sector scenarios, whereas CT and Reflex300 remained on the frontier in SUT and university scenarios. uNIPT was not selected on the frontier and became economically competitive only at substantially reduced unit prices. Conclusions: Reimbursement structure strongly influenced cost‐effectiveness. Contingent NIPT was robust, whereas uNIPT required substantially lower tariff‐aligned pricing to become economically competitive.