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Soukkhaphone B, Baradaran M, Nguyen BD, Nshimyumukiza L, Little J, Rousseau F, Audibert F, Langlois S, Reinharz D. Expansion of non-invasive prenatal screening to the screening of 10 types of chromosomal anomalies: a cost-effectiveness analysis. BMJ Open 2023; 13:e069485. [PMID: 37648381 PMCID: PMC10471875 DOI: 10.1136/bmjopen-2022-069485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 08/18/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To determine the cost-effectiveness of the addition of chromosomal anomalies detectable by non-invasive prenatal screening (NIPS), in a prenatal screening programme targeting common aneuploidies. DESIGN, SETTING AND PARTICIPANTS A simulation study was conducted to study the addition of chromosomal anomalies detectable by NIPS (sex chromosome aneuploidies, 22q11.2 deletion syndrome, large deletion/duplication >7 Mb and rare autosomal trisomies) to five basic strategies currently aiming the common trisomies: three strategies currently offered by the public healthcare systems in Canada, whose first-tier test is performed with biochemical markers, and two programmes whose first-tier test consists of NIPS-based methods. OUTCOME MEASURES The total number of cases of chromosomal anomalies detected and the costs related to the consumption of medical services. RESULTS The most effective and the most cost-effective option in almost all prenatal screening strategies is the option that includes all targeted additional conditions. In the strategies where NIPS is used as first-tier testing, the cost per additional case detected by adding all possible additional anomalies to a programme that currently targets only common trisomies is $C25 710 (95% CI $C25 489 to $C25 934) for massively parallel shotgun sequencing and $C57 711 (95% CI $C57 141 to $C58 292) for targeted massively parallel sequencing, respectively. The acceptability curves show that at a willingness-to-pay of $C50 000 per one additional case detected, the expansion of NIPS-based methods for the detection of all possible additional conditions has a 90% probability of being cost-effective. CONCLUSION From an economic perspective, in strategies that use NIPS as a first-tier screening test, expanding the programmes to detect any considered chromosomal anomalies other than the three common trisomies would be cost-effective. However, the potential expansion of prenatal screening programmes also requires consideration of societal issues, including ethical ones.
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Grants
- PEGASUS 2 project, which funded by Genome Canada, the Canadian Institutes for Health Research, Genome Québec, Genome BC, Genome Alberta, the Québec Ministère de l'enseignement supérieur, de la recherche, de la science et de la technologie, the Fonds de recherche Québec - Santé, la Fondation de l’Université Laval and the Centre de recherche du CHU de Québec
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Affiliation(s)
| | | | | | - Leon Nshimyumukiza
- Laval University, Quebec City, Quebec, Canada
- Institut National d'Excellence en Santé et Services Sociaux, Quebec City, Quebec, Canada
| | | | - Francois Rousseau
- Laval University, Quebec City, Quebec, Canada
- CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Francois Audibert
- CHU Sainte-Justine, Quebec City, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - Sylvie Langlois
- The University of British Columbia, Vancouver, British Columbia, Canada
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Meerschaut I, Rochefort D, Revençu N, Pètre J, Corsello C, Rouleau GA, Hamdan FF, Michaud JL, Morton J, Radley J, Ragge N, García-Miñaúr S, Lapunzina P, Bralo MP, Mori MÁ, Moortgat S, Benoit V, Mary S, Bockaert N, Oostra A, Vanakker O, Velinov M, de Ravel TJ, Mekahli D, Sebat J, Vaux KK, DiDonato N, Hanson-Kahn AK, Hudgins L, Dallapiccola B, Novelli A, Tarani L, Andrieux J, Parker MJ, Neas K, Ceulemans B, Schoonjans AS, Prchalova D, Havlovicova M, Hancarova M, Budisteanu M, Dheedene A, Menten B, Dion PA, Lederer D, Callewaert B. FOXP1-related intellectual disability syndrome: a recognisable entity. J Med Genet 2017; 54:613-623. [PMID: 28735298 DOI: 10.1136/jmedgenet-2017-104579] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/03/2017] [Accepted: 05/11/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Mutations in forkhead box protein P1 (FOXP1) cause intellectual disability (ID) and specific language impairment (SLI), with or without autistic features (MIM: 613670). Despite multiple case reports no specific phenotype emerged so far. METHODS We correlate clinical and molecular data of 25 novel and 23 previously reported patients with FOXP1 defects. We evaluated FOXP1 activity by an in vitro luciferase model and assessed protein stability in vitro by western blotting. RESULTS Patients show ID, SLI, neuromotor delay (NMD) and recurrent facial features including a high broad forehead, bent downslanting palpebral fissures, ptosis and/or blepharophimosis and a bulbous nasal tip. Behavioural problems and autistic features are common. Brain, cardiac and urogenital malformations can be associated. More severe ID and NMD, sensorineural hearing loss and feeding difficulties are more common in patients with interstitial 3p deletions (14 patients) versus patients with monogenic FOXP1 defects (34 patients). Mutations result in impaired transcriptional repression and/or reduced protein stability. CONCLUSIONS FOXP1-related ID syndrome is a recognisable entity with a wide clinical spectrum and frequent systemic involvement. Our data will be helpful to evaluate genotype-phenotype correlations when interpreting next-generation sequencing data obtained in patients with ID and/or SLI and will guide clinical management.
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Affiliation(s)
- Ilse Meerschaut
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Daniel Rochefort
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Nicole Revençu
- Centre de Génétique humaine, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Justine Pètre
- Centre de Génétique humaine, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | | | - Guy A Rouleau
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Fadi F Hamdan
- CHU Sainte-Justine Research Center, Université de Montreal, Montreal, Canada
| | - Jacques L Michaud
- CHU Sainte-Justine Research Center, Université de Montreal, Montreal, Canada
| | - Jenny Morton
- West Midlands Regional Clinical Genetics Service and Birmingham Health Partners, Birmingham Women's Hospital NHS Foundation Trust, Birmingham Women's Hospital, Edgbaston, UK
| | - Jessica Radley
- West Midlands Regional Clinical Genetics Service and Birmingham Health Partners, Birmingham Women's Hospital NHS Foundation Trust, Birmingham Women's Hospital, Edgbaston, UK
| | - Nicola Ragge
- West Midlands Regional Clinical Genetics Service and Birmingham Health Partners, Birmingham Women's Hospital NHS Foundation Trust, Birmingham Women's Hospital, Edgbaston, UK
| | - Sixto García-Miñaúr
- Instituto de Genética Médica y Molecular, Hospital Universitario La Paz, IdiPAZ, CIBERER, ISCIII, Madrid, Spain
| | - Pablo Lapunzina
- Instituto de Genética Médica y Molecular, Hospital Universitario La Paz, IdiPAZ, CIBERER, ISCIII, Madrid, Spain
| | - Maria Palomares Bralo
- Instituto de Genética Médica y Molecular, Hospital Universitario La Paz, IdiPAZ, CIBERER, ISCIII, Madrid, Spain
| | - Maria Ángeles Mori
- Instituto de Genética Médica y Molecular, Hospital Universitario La Paz, IdiPAZ, CIBERER, ISCIII, Madrid, Spain
| | - Stéphanie Moortgat
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Gosselies, Belgium
| | - Valérie Benoit
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Gosselies, Belgium
| | - Sandrine Mary
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Gosselies, Belgium
| | - Nele Bockaert
- Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Ann Oostra
- Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Olivier Vanakker
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Milen Velinov
- NYS Institute for Basic Research in Developmental Disabilities, Staten Island, New York, USA
| | - Thomy Jl de Ravel
- Centre for Human Genetics, University Hospital Leuven, Leuven, Belgium
| | - Djalila Mekahli
- Department of Pediatric Nephrology, University Hospital Leuven, Leuven, Belgium
| | - Jonathan Sebat
- Beyster Center for Genomics of Psychiatric Diseases, University of California, San Diego, USA
| | - Keith K Vaux
- Departments of Medicine and Neurosciences, UC San Diego School of Medicine, San Diego, USA
| | - Nataliya DiDonato
- Institut für Klinische Genetik, Technische Universität Dresden, Dresden, Deutschland
| | - Andrea K Hanson-Kahn
- Department of Pediatrics, Division of Medical Genetics, Stanford University School of Medicine, California, USA
| | - Louanne Hudgins
- Department of Pediatrics, Division of Medical Genetics, Stanford University School of Medicine, California, USA
| | - Bruno Dallapiccola
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luigi Tarani
- Department of Pediatrics and Child Neuropsychiatry, La Sapienza University, Rome, Italy
| | - Joris Andrieux
- Institut de Génétique Médicale, Hospital Jeanne de Flandre, Lille, France
| | - Michael J Parker
- Sheffield Clinical Genetics Service, Sheffield Children's Hospital, Sheffield, UK
| | | | - Berten Ceulemans
- Department of Neurology-Pediatric Neurology, Antwerp University Hospital, Edegem, Belgium
| | - An-Sofie Schoonjans
- Department of Neurology-Pediatric Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Darina Prchalova
- Department of Biology and Medical Genetics, Charles University 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech
| | - Marketa Havlovicova
- Department of Biology and Medical Genetics, Charles University 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech
| | - Miroslava Hancarova
- Department of Biology and Medical Genetics, Charles University 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech
| | - Magdalena Budisteanu
- Psychiatry Research Laboratory, Prof Dr Alexandru Obregia Clinical Hospital of Psychiatry, Bercini, Romania
| | - Annelies Dheedene
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Björn Menten
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Patrick A Dion
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Damien Lederer
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Gosselies, Belgium
| | - Bert Callewaert
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
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