Miriam Kuppermann1,2, Mary E Norton1, Kao Thao1, Allison O'Leary1, Onouwem Nseyo1, Abigail Cortez1, Anjali J Kaimal3. 1. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA. 2. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. 3. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.
Abstract
OBJECTIVES: To compare utilities for prenatal testing outcomes among women inclined to continue their pregnancy despite abnormal results versus those inclined to terminate and to analyze how differences affect optimal prenatal testing strategies. METHOD: Time tradeoff utilities for 23 outcomes were elicited from 281 women. We compared utilities based on termination inclination and applied them to a decision-analytic framework. RESULTS: Of participants, 46.6% indicated that they would 'definitely' or 'probably' continue their pregnancy despite results indicating an intellectual disability. These women assigned higher utilities to abnormal testing results and having a child with an intellectual disability than women who would probably or definitely terminate. Primary cell-free DNA screening had the most quality-adjusted life years for women inclined to continue their pregnancy but yielded an incremental cost-effectiveness ratio (ICER) of $1 685 449. Multiple marker screening with either cell-free DNA or diagnostic testing as follow-up had an ICER of $9037. Primary diagnostic testing resulted in the most quality-adjusted life years for women inclined to terminate, with an ICER of $111 776. CONCLUSION: Women seeking testing vary in prenatal testing outcome preferences and termination inclinations in the context of results indicating an intellectual disability. How they envision utilizing prenatal testing information impacts their optimal testing strategy.
OBJECTIVES: To compare utilities for prenatal testing outcomes among women inclined to continue their pregnancy despite abnormal results versus those inclined to terminate and to analyze how differences affect optimal prenatal testing strategies. METHOD: Time tradeoff utilities for 23 outcomes were elicited from 281 women. We compared utilities based on termination inclination and applied them to a decision-analytic framework. RESULTS: Of participants, 46.6% indicated that they would 'definitely' or 'probably' continue their pregnancy despite results indicating an intellectual disability. These women assigned higher utilities to abnormal testing results and having a child with an intellectual disability than women who would probably or definitely terminate. Primary cell-free DNA screening had the most quality-adjusted life years for women inclined to continue their pregnancy but yielded an incremental cost-effectiveness ratio (ICER) of $1 685 449. Multiple marker screening with either cell-free DNA or diagnostic testing as follow-up had an ICER of $9037. Primary diagnostic testing resulted in the most quality-adjusted life years for women inclined to terminate, with an ICER of $111 776. CONCLUSION:Women seeking testing vary in prenatal testing outcome preferences and termination inclinations in the context of results indicating an intellectual disability. How they envision utilizing prenatal testing information impacts their optimal testing strategy.
Authors: Ruth M Farrell; Madelyn Pierce; Christina Collart; Meng Yao; Marissa Coleridge; Edward K Chien; Susannah S Rose; Mary Lintel; Uma Perni; Brownsyne Tucker Edmonds Journal: BMC Pregnancy Childbirth Date: 2021-12-04 Impact factor: 3.007