Professor Eva Pajkrt:

We were actually quite late in introducing a prenatal screening programme in the Netherlands. We introduced our programme in 2007. There are two elements to the programme. Women are first asked if they want to receive information about prenatal screening. If the answer is affirmative, we offer the information but women have a right not to know. It is a strong belief that if women do not want all of the information, we should not give it to them. If the woman says that she would like to have the information, she is counselled about the fact that there is a possibility of being screened for chromosomal anomalies. That used to be done via the combined test. We still have the combined test but since April 2017, we now offer the non-invasive prenatal test, known as the NIPT, a blood test which determines if it is likely that the baby has trisomy 21, 18 and 13. The NIPT is more sensitive than the combined test in detecting foetal trisomies. However, it lacks the ability to see other problems in the foetus at an early stage. Every woman is counselled about the 20 week scan and is offered such a scan, which we actually try to perform at around 19 weeks. We do this because we feel that if there is an anomaly, one needs time to do further investigations. Such investigations take time and it is better if one has a little bit more time so that women do not have to rush into making decisions.

The uptake of screening in the Netherlands for the combined test has always been around 40%. However, it is very regionally dependent. In Amsterdam, where we work, it is quite high but in more rural areas, the uptake is lower. It is also quite low in the north of Holland. It depends a little on where one lives. We thought that once we introduced NIPT in the Netherlands that women would just rush to have it but that has not happened. The uptake has stayed more or less the same. It may be a little bit higher but it is not something that everyone is rushing into. One of the arguments put forward to explain this is that the combined test and the NIPT are not free in the Netherlands. One must pay €169 for the entire combined test or €175 for NIPT. The rest of the cost of NIPT, which is more expensive than that, is paid for by the Ministry of Health. It is a study so it is under a study protocol and the licence runs to 1 April 2020. It will be evaluated then to determine how well it is working. Women have to pay for that. However, the 20 week scan is free. If one has health care in the Netherlands and one receives a treatment, one must pay the first €385 but there are certain treatments not included in that. The 20 week scan is one such treatment. If that is the only treatment one receives in a year, the health insurance companies will pay for it. The uptake of the 20 week scan is quite difficult to determine. We have everyone in a database who has the scan but it is more difficult to figure out who is not in the database. We estimate, however, that the uptake is around 95%.