An Economic Evaluation On Prenatal Diagnosis Strategies For Down's Syndrome

BackgroundAs a serious birth defect characterized with low intelligence, body dysfunction and excessive abnormality, Down's Syndrome(DS) will not only bring lifetime suffering to patients and their family, but also consume massive resources for family and society caring to the patients. Until now, there is no effective therapy to DS patients; the only one meaningful way is to carry out prenatal diagnosis of DS so as to avoid DS births.Whereas DS's huge harmfulness, all levels of governments have launched related researches in recent years. Under this favorable circumstance, it is important and necessary to measure disease burden of DS and conduct economic evaluation on prenatal diagnosis strategies for DS and provide a scientific and objective evidence, which is helpful not only to identify effective interventions, but also to enrich prevention and control system of birth defects.ObjectivesGeneral objective of the study is to conduct economic evaluations on prenatal diagnosis strategies for DS from societal perspective, based on current situation in China. As a result, researches will provide scientific evidence for policy-makers to develop an cost-effective and feasible strategy to prevent DS.The specific objectives are as follows:1. To measure the disease burden of DS, and benefit of prenatal diagnosis for DS is estimated by avoided disease burden;2. To evaluate efficacy and safety of prenatal diagnosis strategies for DS;3. To compare cost-effectiveness and cost-benefit of prenatal diagnosis strategies for DS;4. To measure standard unit cost of prenatal diagnosis for DS.Research contents1, Measuring burden of DS through quantitative and qualitative methods.2, Using decision tree model to simulate DS births avoided and normal fetusabortions induced by diagnosis procedures under different prenatal diagnosis strategies.3 , Comparing and analyzing cost-effectiveness and cost-benefit of different prenatal diagnosis strategies for DS.4 , Measuring standard cost of prenatal diagnosis items for DS.Methods1. Diseases economic burden methods. Researchers investigated DS families in Shanghai, Hebei and Shanxi. The incidence method was employed to measure lifetime economic burden of a DS birth and that of all new cases in China in 2003, based on DS patient' actual health services utilization and survival rate of different age of DS, from societal perspective.2. Qualitative research. Researchers have selected purposely 18 members of DS family to describe patient's intangible burden. Interviewees should be those living with DS patients in a long period time and knew DS patients well. Furthermore, DS patients must be more than 5 years.3. Economic appraisal of prenatal diagnosis strategies of DS. Researchers have developed a decision tree model to simulate expected health outcomes of 10000 pregnant under different strategies based on the results of field surveys, expert consultations and literature reviews. Then, researchers conducted cost effectiveness analysis and cost benefit analysis on prenatal diagnosis strategies for DS.4. Standard cost of prenatal diagnosis items of DS. Researchers employed standard cost accounting to estimate prenatal screening and diagnosis items standard cost based on field survey, expert consultations and literature review.Main findings1. Burden of DS1) Economic burden caused by a new DS birth will be 450.43 thousand Yuan and social economic lose due to all new DS cases in China in 2003 amount to 6.825 billion Yuan.2) Intangible burden of DS shows DS family' heavy psychological burden, outside discrimination, family relationship deterioration, less opportunity ofemployment and development as well as being anxious for future life.2. Economic evaluation of prenatal diagnosis of DS1) There are 3 prenatal diagnosis strategies of DS currently, including do-nothing (strategy 1), prenatal diagnosis provided merely to those aged above 35 with higher risk(strategy 2), all pregnant women screened by AFP+HCG, then diagnosis procedure taken to those with a positive screening result (strategy 3). Do-nothing could not avoid any DS births, strategy 2 could reduce 0.67 DS birth per ten thousand pregnant and cause 1.13 normal fetus miscarriage while strategy 3 could find 1.39 DS and induce 0.8 miscarriage due to diagnosis procedure.2) In order to avoid 1 DS birth, strategy 2 and 3 will spend 72 and 652 thousand yuan respectively. Considering incremental cost effectiveness, strategy 3 will spend 800.59 thousand yuan more than that of strategy 2.3) Net present value of implementing strategy 2 and 3 will be -281 and -384 thousand yuan respectively.4) If screening unit cost could be lowered down, strategy 3 will be improved greatly in terms of cost-effectiveness and cost-benefit.3. Standard cost of prenatal diagnosis items for DS1) If annual screening volume of a health institution could reach 20 to 30 thousand, screening unit cost could be lower than 70 yuan. As a result, economic effectiveness of strategy 3 will be improved greatly.2) It is common that charge of prenatal screening is higher than its standard cost, in contrast, charge of prenatal diagnosis item is lower than standard cost. Thus, it is necessary to adjust pricing of prenatal diagnosis of DS.Main conclusions1. The economic burden caused by DS is dramatically. Effective measures should be taken to reduce and avoid DS births.2. Among prenatal diagnosis strategies implemented in China, the third strategy, should be considered as priority.3. Under the current condition of low screening coverage and compliance to diagnosis procedure, some measures should be taken to improve the cost-effectiveness and cost-benefit of the third strategy.4. If screening volume of a prenatal diagnosis institutions could be increased by...