Sharon J M Kessels1, Drew Carter2, Benjamin Ellery1, Skye Newton1, Tracy L Merlin1. 1. Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia. 2. Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia. drew.carter@adelaide.edu.au.
Abstract
PURPOSE: We aimed to assess the clinical value of prenatal testing for cystic fibrosis (CF) and whether ethical considerations would affect endpoint selection. METHODS: To determine effectiveness, we conducted a systematic literature review whose protocol outlined search strategies across eight databases, study inclusion criteria, and prespecified literature screening, data extraction, and synthesis processes. We conducted a scoping search on ethical considerations. RESULTS: The genetic test showed good diagnostic performance. A change in clinical management was observed: termination of pregnancy (TOP) occurred in most cases where two pathogenic variants were identified in a fetus of carrier parents (158/167; 94.6%). The TOP rate was lower in pregnancies where CF was diagnosed after fetal echogenic bowel detection (~65%). TOP and caring for a child with CF were both associated with poor short-term parental psychological outcomes. Ethical analyses indicated that informed decisions should have been the main endpoint, rather than CF-affected births prevented. CONCLUSION: CF testing leads to fewer CF-affected births. It is difficult to assess whether this means the test is valuable, since patients may not value TOP primarily in terms of maternal or fetal health outcomes, psychological or otherwise. The value of testing should arguably be measured in terms of improving patient autonomy rather than health.
PURPOSE: We aimed to assess the clinical value of prenatal testing for cystic fibrosis (CF) and whether ethical considerations would affect endpoint selection. METHODS: To determine effectiveness, we conducted a systematic literature review whose protocol outlined search strategies across eight databases, study inclusion criteria, and prespecified literature screening, data extraction, and synthesis processes. We conducted a scoping search on ethical considerations. RESULTS: The genetic test showed good diagnostic performance. A change in clinical management was observed: termination of pregnancy (TOP) occurred in most cases where two pathogenic variants were identified in a fetus of carrier parents (158/167; 94.6%). The TOP rate was lower in pregnancies where CF was diagnosed after fetal echogenic bowel detection (~65%). TOP and caring for a child with CF were both associated with poor short-term parental psychological outcomes. Ethical analyses indicated that informed decisions should have been the main endpoint, rather than CF-affected births prevented. CONCLUSION: CF testing leads to fewer CF-affected births. It is difficult to assess whether this means the test is valuable, since patients may not value TOP primarily in terms of maternal or fetal health outcomes, psychological or otherwise. The value of testing should arguably be measured in terms of improving patient autonomy rather than health.
Authors: C Guissart; C Dubucs; C Raynal; A Girardet; F Tran Mau Them; V Debant; C Rouzier; A Boureau-Wirth; E Haquet; J Puechberty; E Bieth; D Dupin Deguine; P Khau Van Kien; M P Brechard; V Pritchard; M Koenig; M Claustres; M C Vincent Journal: J Cyst Fibros Date: 2016-12-28 Impact factor: 5.482
Authors: Alessandro Liberati; Douglas G Altman; Jennifer Tetzlaff; Cynthia Mulrow; Peter C Gøtzsche; John P A Ioannidis; Mike Clarke; P J Devereaux; Jos Kleijnen; David Moher Journal: PLoS Med Date: 2009-07-21 Impact factor: 11.069
Authors: Samuel M Moskowitz; James F Chmiel; Darci L Sternen; Edith Cheng; Ronald L Gibson; Susan G Marshall; Garry R Cutting Journal: Genet Med Date: 2008-12 Impact factor: 8.822
Authors: Zoran Laurentiu Popa; Madalin-Marius Margan; Izabella Petre; Elena Bernad; Lavinia Stelea; Veronica Daniela Chiriac; Marius Craina; Ioana Mihaela Ciuca; Anca Mihaela Bina Journal: Int J Environ Res Public Health Date: 2022-07-17 Impact factor: 4.614