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Cost effectiveness of antenatal screening for cystic fibrosis
H S Cuckle1, G A Richardson, T A Sheldon
1Centre for Reproduction, Growth and Development, Research School of Medicine, University of Leeds, UK.
Insights
Estimating the cost-effectiveness of antenatal screening for cystic fibrosis (CF) shows sequential screening ranges from £40,000-£90,000 per affected pregnancy. Couple screening is more costly, informing UK National Health Service (NHS) policy decisions.
Area of Science:
- Health Economics
- Medical Screening
- Genetic Disorders
Background:
- Cystic fibrosis (CF) is a significant genetic disorder requiring effective antenatal screening.
- Estimating the cost-effectiveness of different screening strategies is crucial for healthcare policy.
Purpose of the Study:
- To evaluate the cost-effectiveness of various antenatal screening programs for cystic fibrosis (CF) in the United Kingdom.
- To provide data to inform the National Health Service (NHS) regarding the implementation of CF screening services.
Main Methods:
- A cost-effectiveness analysis was conducted using data from antenatal clinics and general practices.
- Screening components included information giving, DNA testing, genetic counseling, and prenatal diagnosis.
- Costs were calculated for sequential and couple screening strategies, considering carrier detection rates and uptake, with sensitivity analyses performed.
Main Results:
- Sequential screening for CF costs between £40,000 and £90,000 per affected pregnancy detected.
- Couple screening was found to be more expensive, ranging from £46,000 to £104,000 per affected pregnancy.
- Sensitivity analysis indicated that changes in assumptions about prior information, partner changes, and prenatal diagnosis uptake significantly impact overall costs.
Conclusions:
- Economic analysis provides essential data for informed decision-making on CF screening policy.
- The study offers the NHS crucial cost-effectiveness information for potential introduction of a cystic fibrosis screening service.
Objective:
To estimate the cost effectiveness of different antenatal screening programmes for cystic fibrosis.
Setting:
Antenatal clinics and general practices in the United Kingdom.
Design:
Four components of the screening process were identified: information giving, DNA testing, genetic counselling, and prenatal diagnosis. The component costs were derived from the literature and from a pilot screening study in Yorkshire. The cost of a given screening programme was then obtained by summing the components according to the specific screening strategy adopted (sequential and couple), the proportion of carriers detected by the DNA test, and the uptake of screening. Baseline assumptions were made about the proportion with missing information on carrier status from previous pregnancies (20%), the proportion changing partners between pregnancies (20%), and the uptake of prenatal diagnosis (100%). Sensitivity analysis was performed by varying these assumptions.
Main Outcome Measure:
Cost per affected pregnancy detected.
Results:
Under the baseline assumptions sequential screening costs between pounds 40,000 and pounds 90,000 per affected pregnancy detected, depending on the carrier detection rate and uptake. Couple screening was more expensive, ranging from pounds 46,000 to pounds 104,000. From the sensitivity analysis a 10% change in the assumed proportion with missing information from a previous pregnancy alters the cost by pounds 4000; a 10% change in the proportion with new partners has a similar effect but only for couple screening; and cost will change directly in proportion to the uptake of prenatal diagnosis.
Conclusions:
While economic analysis cannot determine screening policy, the paper provides the NHS with the information on cost effectiveness needed to inform decisions on the introduction of a screening service for cystic fibrosis.