Premium
Impact of observed versus hypothesized service utilization on the incremental cost of first trimester screening and prenatal diagnosis for trisomy 21 in a Canadian province
Author(s) -
Metcalfe Amy,
Currie Gillian,
Johnson JoAnn,
Bernier Francois,
Lix Lisa M.,
Lyon Andrew W.,
Tough Suzanne C.
Publication year - 2013
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.4082
Subject(s) - trisomy , pregnancy , medicine , prenatal diagnosis , prenatal care , obstetrics , population , prenatal screening , cohort , down syndrome , second trimester , aneuploidy , fetus , pediatrics , environmental health , psychiatry , biochemistry , genetics , chemistry , gene , chromosome , biology
Objective The aim of this research was to determine the impact of observed versus hypothesized service utilization on the cost of first trimester screening (FTS) and prenatal diagnosis for trisomy 21 in a Canadian province. Methods A population‐based pregnancy cohort was created by linking 12 clinical and administrative databases. Care trajectories were derived to examine utilization patterns for FTS, prenatal diagnosis, and pregnancy termination. A literature review was conducted to determine what utilization parameters were used in economic evaluations of FTS. Local cost data was applied to observed and hypothesized care trajectories. Results The observed mean cost per fetus with trisomy 21 detected prenatally using FTS was $129 606.04 compared with $27 021.45 for women who did not access FTS. Observed utilization of FTS and prenatal diagnosis among screen positive women and termination of pregnancy following prenatal diagnosis of trisomy 21 were substantially lower than hypothesized in existing cost effectiveness studies. Cost estimates were sensitive to hypothetical changes in utilization of prenatal screening, prenatal diagnosis, and pregnancy termination. Conclusion Literature‐based estimates of the cost‐effectiveness of prenatal screening may not accurately represent current local practice due to potentially unrealistic assumptions about what proportion of women will proceed to invasive testing and ultimately terminate an affected pregnancy. © 2013 John Wiley & Sons, Ltd.