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Genetic screening for reproductive planning: methodological and conceptual issues in policy analysis
D A Asch1, J C Hershey, M V Pauly
1Division of General Internal Medicine, VA Medical Center, Philadelphia, PA 19104-2676, USA.
American Journal of Public Health
|May 1, 1996
Summary
Cost-effectiveness analyses for genetic screening in reproductive settings involve critical assumptions and methodological choices. Understanding these issues is vital for accurate interpretation by clinicians and researchers.
Area of Science:
- Health Economics
- Genetics
- Reproductive Medicine
Background:
- Cost-effectiveness analyses (CEA) are crucial for evaluating genetic screening strategies.
- Reproductive genetic screening involves complex decision-making processes.
Purpose of the Study:
- To explore critical assumptions and methodological issues in CEA of reproductive genetic screening.
- To highlight the impact of these choices on analysis interpretation.
Main Methods:
- Discussion of seven specific issues encountered in developing a decision analysis for cystic fibrosis carrier screening.
- Examination of the technical choices made to address these issues.
Main Results:
- CEA presentations often obscure underlying assumptions and methodological decisions.
- No single 'best' choice exists for many methodological issues.
- Genetic screening issues intersect with deeply held human values.
Conclusions:
- Publication constraints limit detailed explanation of methodological choices.
- Clarity on assumptions and their implications is essential for clinicians.
- Clinicians must improve understanding of CEA models and their ethical/economic context.
Keywords:
Genetics and Reproduction