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Establishing an optimal first trimester aneuploidy screening approach– an economic evaluation

School of Medicine, Dentistry and Biomedical Sciences | PHD

Applications are now CLOSED
Funding
Funded
Reference Number
SMED-2251-1026
Application Deadline
3 March 2025
Start Date
1 June 2025

Overview

Implementing the preferred screening approach for patients, the public and stakeholders regarding early pregnancy chromosome differences focusing on cost.

We are seeking a midwife or clinician to complete this PhD. In Great Britain (GB) pregnant people are offered a screening test between 11 and 14 weeks to assess the chance of having a baby with Down’s, Edwards and Patau syndrome. These syndromes are common (1 in every 1000 pregnancies).

There are two approaches to screening. Both are based on the testing of baby’s DNA in the pregnant person’s blood (non-invasive prenatal testing or ‘NIPT’) which is more sensitive than traditional screening methods. The first approach works by going directly to NIPT and the second works by performing an initial baseline risk calculation based on age, ultrasound of the baby and other blood tests and subsequently offering NIPT based on this risk. There are pros and cons to either approach and it has not been determined which approach is the most accurate. Importantly there has been no evaluation, informed by the preferences of pregnant people and other stakeholders, of which approach would be the more cost-saving and with least impact on the healthcare system.

Northern Ireland (NI) is unique in that pregnant people don’t have access to any early pregnancy screening which means their reproductive choices are limited and there is a significant negative impact on them, their families and the health service. It hasn’t yet been assessed in NI how many pregnant people would like to have early screening nor what their preferences might be in how this is done. It is important that NI, as a unique population, decides which approach works best with the resources available. Not only does this situation represent a stark health inequality, but also an opportunity to determine which is the optimal tailored screening approach for the population by assessing this in a group without prior experience or biases towards either approach.

The aim of this study is to find out which is the best screening approach for the people and health service of NI and how best to implement it and involves two PhD projects. This project will involve a review of existing data to see the current state of play within the NI health service of not having screening, a review of existing literature as to which screening approach is more cost-effective as well as a cost consequence evaluation for NI based on pregnant people’s preferences. We will then identify the best way to implement screening, and what barriers and facilitators will be important, informed by patient and public and multiple stakeholder involvement with an aim for implementation of the optimal screening method within 5-years. When translated into clinical practice, this will optimise reproductive choice in NI and provide insights into the optimal approach for first trimester screening for the rest of the UK and internationally. Training and supervision from appropriate experts in the field will be provided.

Funding Information

The value of the studentship covers student fees and an enhanced stipend.

Project Summary
Supervisor

Dr Fionnuala Mone

Research Profile

Mode of Study

Full-time: 3 Years

Funding Body
BHSCT Charitable Funds
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