Suchergebnisse

BACKGROUND: Non-invasive prenatal testing (NIPT) using cell-free fetal DNA in maternal plasma is a high accurate test for prenatal screening for Down syndrome. Although it has been reported to be cost effective as a contingent test, evidence about its budget impact is lacking. OBJECTIVE: To evaluate, using computer simulations, the budget impact of implementing NIPT as a contingent test in the Quebec Program of screening for Trisomy 21. METHODS: A semi-Markov analytic model built to simulate the budget impact of implementing NIPT into the current Quebec Trisomy 21 public Prenatal Screening, Serum Integrated prenatal screening (SIPS). Comparisons were made for a virtual population similar to that of expected Quebec pregnant women in 2015 in terms of size and age. Data input parameters were retrieved from a thorough literature search and in government databases, especially data from Quebec Program of screening for Trisomy 21. The 2015–2016 fiscal year budget impact was estimated from the Quebec healthcare system perspective and was expressed as the difference in the overall costs between the two alternatives (SIPS minus SPS + NIPT). RESULTS: Our study found that, at a baseline cost for NIPT of CAD$ 795, NIPT as a second-tier test offered to high-risk women identified by current screening program (SIPS + NIPT) may be affordable for Quebec health care system. Compared to the current screening program, it would be implemented at a neutral cost, considering a modest annual savings of $ 80,432 (95% CI $ 79, $ 874–$ 81,462). Results were sensitive to the NIPT costs and the uptake-rate of invasive diagnostic tests. CONCLUSION: Introducing NIPT as a contingent test in the Quebec Trisomy 21 screening program is an affordable strategy compared to the current practice. Further research is needed to confirm if our results can be reproduced in other healthcare jurisdictions.

House mice ( Mus musculus ) were introduced to South Africa's sub-Antarctic Marion Island, the larger of the two Prince Edward Islands, by sealers in the early 19th century. Over the last two centuries they have greatly reduced the abundance of native invertebrates. Domestic cats ( Felis catus ) taken to the island in 1948 to control mice at the South African weather station soon turned feral, killing large numbers of breeding seabirds. An eradication programme finally removed cats from the island by 1991, in what is still the largest island area cleared of cats at 290 km2. Removal of the cats, coupled with the warmer and drier climate on the island over the last half century, has seen increasing densities of mice accumulating each summer. As resources run out in late summer, the mice seek alternative food sources. Marion is home to globally important seabird populations and since the early 2000s mice have resorted to attacking seabird chicks. Since 2015 c. 5% of summer-breeding albatross fledglings have been killed each year, as well as some winter-breeding petrel and albatross chicks. As a Special Nature Reserve, the Prince Edward Islands are afforded the highest degree of protection under South African environmental legislation. A recent feasibility plan suggests that mice can be eradicated using aerial baiting. The South African Department of Environmental Affairs is planning to mount an eradication attempt in the winter of 2021, following a partnership with the Royal Society for the Protection of Birds to eradicate mice on Gough Island in the winter of 2020. The eradication programme on Marion Island will be spearheaded by the South African Working for Water programme – Africa's biggest conservation programme focusing on the control of invasive species –which is already driving eradication projects against nine other invasive species on Marion Island.