An editorial piece published in Hong Kong Medical Journal makes a case for universal access to noninvasive prenatal screening (NIPS) as the first-line screening option within Hong Kong’s public healthcare system – on the basis of women’s preferences and its clinical superiority vs first-trimester combined screening (FTS). [Hong Kong Med J 2026;32:287-290]
Currently, Hong Kong’s public healthcare system offers FTS, consisting of maternal serum biochemistry and nuchal translucency ultrasound, to all pregnant women. FTS’s detection rate of trisomy 21 is 91.2 percent, with a false-positive rate of 5 percent. [Hong Kong Med J 2013;19:101-108] Women with a high-risk FTS result are subsequently offered NIPS as a second-tier test, which screens cell-free fetal DNA in maternal blood for chromosomal abnormalities. NIPS’ sensitivity for trisomy 21 is ≥99 percent, with a false-positive rate <0.1 percent. [Ultrasound Obstet Gynecol 2017;50:302-314]
Notably, local data show that 67 percent of pregnant women in Hong Kong opt for a self-financed NIPS, which costs HKD 4,000–8,000 in the private sector. [Hong Kong Med J 2020;26:10-18] This indicates that many women choose to have NIPS despite receiving a low-risk FTS result.
Reducing stress and anxiety
Under the existing model, women with a high-risk FTS result face a second waiting period for subsequent tests and their results. A survey conducted in England and France found that women viewed this two-step process as generating stress and anxiety because of false alarms, and expressed a clear preference for a more reliable test at the outset. [J Genet Couns 2024;33:1204-1214]
Studies investigating women’s motivations for undergoing NIPS consistently demonstrate a desire for as much information as possible about their pregnancy and show an overwhelming preference for first-tier NIPS. [Pregnancy Childbirth 2019;19:22; PLoS One 2016;11:e0153147] The fact that women in Hong Kong with low-risk FTS results still choose self-financed NIPS suggests psychological reassurance and maximal certainty are important considerations for expectant mothers. [PLoS One 2013;8:e81794]
Maximizing number of beneficiaries
Although NIPS remains relatively expensive, costs continue to decrease as the technology matures. In addition, it may be possible to mitigate costs within the public healthcare system by offering a limited panel targeting only common trisomies (21, 18, and 13), for which NIPS performance has been validated in both high- and general-risk populations. [Genet Med 2023;25:100874; Genet Med 2022;24:1992] The option of expanded NIPS in the private sector would still be available for women who desire additional information and have received appropriate counselling.
Alternatively, a copayment model could also help bridge the gap between current costs and universal access. Research shows that most women are willing to pay a modest amount for a better test. [Aust N Z J Obstet Gynaecol 2025;65:409-419] A utilitarian analysis of public funding for NIPS in Hong Kong similarly concluded that offering NIPS with a small copayment, alongside government subsidies for women with limited financial means, would maximize the number of beneficiaries. [IntechOpen 2023doi:10.5772/intechopen.1002945]
Experience in China and the Netherlands
In Hebei Province in mainland China, implementation of first-tier NIPS across 1.19 million pregnancies reduced prenatal diagnostic procedures by 97.4 percent and demonstrated improved cost-effectiveness. [Nature Health 2026;1:657-665] First-tier NIPS in the Netherlands achieved a 73 percent reduction in invasive procedures while maintaining high rates of informed choice. [Prenat Diagn 2023;43:443-447]
“As this clinically superior test becomes increasingly available, more cost-effective, and preferred by women and healthcare professionals, the rationale for retaining FTS becomes progressively more difficult to justify,” concluded the authors.