Related Experiment Videos
A cost-effectiveness analysis of prenatal carrier screening for cystic fibrosis
A M Vintzileos1, C V Ananth, J C Smulian
1Department of Obstetrics and Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School/St. Peter's Medical Center, New Brunswick 08903, USA. vintziam@umdnj.edu
Insights
Prenatal carrier screening for cystic fibrosis is cost-effective for white populations, offering significant savings. However, it is not cost-effective for black, Asian, or Hispanic individuals.
Area of Science:
- Medical Genetics
- Health Economics
Background:
- Cystic fibrosis (CF) is a genetic disorder with significant lifetime costs.
- Prenatal diagnosis offers an opportunity to manage CF cases.
Purpose of the Study:
- To evaluate the cost-effectiveness of prenatal carrier screening for cystic fibrosis.
- To determine the optimal cost per screening test and net cost savings for different racial/ethnic groups.
Main Methods:
- A cost-benefit equation was developed, comparing screening costs to the lifetime costs of CF.
- Sensitivity analyses were performed on key variables like screening cost, acceptance, and abortion rates.
- The model was adjusted for repeat testing in subsequent pregnancies.
Main Results:
- Prenatal screening for CF is cost-effective for white populations, with net savings of $58,369-$382,369 per case.
- Annual cost savings for whites in the U.S. are estimated at $161-251 million.
- The screening program was not cost-effective for black, Asian, or Hispanic populations.
Conclusions:
- Prenatal cystic fibrosis carrier screening is generally cost-effective under various assumptions.
- Cost-effectiveness varies significantly across different racial and ethnic groups.
Objective:
To examine the cost-effectiveness of prenatal carrier screening for cystic fibrosis.
Methods:
A cost-benefit equation was developed that was based on the hypothesis that the cost of prenatal diagnosis required to diagnose and prevent one case of cystic fibrosis should be equal to or less than the lifetime cost generated from the birth of a neonate with cystic fibrosis. The formula was adjusted because a woman's positive or negative carrier status remains unchanged, thus eliminating the need for testing in subsequent pregnancies. The formula was manipulated to identify the optimal cost per screening test, as well as the net cost savings per prenatally diagnosed case of cystic fibrosis for various racial or ethnic groups. Sensitivity analyses included some key assumptions regarding the cost per screening test ($50-150), patient screening acceptance rates (25-100%), and therapeutic abortion rates (50-100%).
Results:
Assuming therapeutic abortion rates of 50-100%, the net savings per prenatally diagnosed case of cystic fibrosis are $58,369-$382,369 among whites. Given the previously reported patient screening acceptance rates of 50-78%, the overall annual cost savings in the United States for whites are $161-251 million. However, the screening program was not found to be cost-effective for blacks, Asians, or Hispanics.
Conclusion:
Under most assumptions and sensitivity analyses, a prenatal cystic fibrosis-carrier screening program appears to be cost-effective.