Case Synopsis

Since 1993, the Ontario Ministry of Health and Long-Term Care (MOHLTC) has financed prenatal genetic screening through its provincial health insurance plan. In 2013, a new technology became available. Non-invasive prenatal testing (NIPT) promises improved accuracy and screening safety at a higher cost than other screening tests. Since 2013, pregnant women in Ontario have been paying for the test themselves. In March 2014, the Ministry appointed a Prenatal Genetic Screening Group (PGSG), to make recommendations on making NIPT available through the provincial health insurance plan. The Ministry requested an economic evaluation, appraising the value of NIPT.

Case Objectives

  1. Understand the role of economic evaluation in health policy decision-making
  2. Critically appraise the quality of an economic evaluation and evaluate its applicability
  3. Interpret economic evaluations and use the results to inform policy recommendations
  4. Discuss the challenges of interpreting cost-effectiveness analysis as compared to cost-utility analysis
  5. Consider broader social, political, and ethical concerns such as equity, quality assurance, allocative efficiency, and appropriate use of screening in making health policy decisions

Case Study Questions

  1. How should scarce resources be allocated within a publically funded healthcare system?
  2. What type of economic evaluation was performed (cost-minimization, cost-effectiveness, cost-utility, cost-benefit)?
  3. How would you appraise the quality of the economic evaluation? Is it adequate for use in policy decision-making?
  4. What are the challenges associated with using the cost per case of Down syndrome diagnosed as a measure of value for money? Are there additional analyses you would recommend?
  5. What recommendations would you make about NIPT screening based on the results of economic evaluation?
  6. Are there important factors not addressed by the economic evaluation?
  7. Should the ministry allocate resources to supporting parents of children with Down syndrome?


economic evaluation, cost-effectiveness analysis, genetic screening, Down syndrome.

Additional Author Information

Dawn Beck, RN, MPH

Julie Toole, RM, MHSc, Risk Management Specialist

Ava John-Baptiste, PhD, Assistant Professor



Recommended Citation

Beck, D., Toole, J., John-Baptiste, A., (2015). Deciding Value for Money: Improving Prenatal Genetic Screening in Ontario in: Speechley, M., & Terry, A.L. [eds] Western Public Health Casebook 2015. London, ON: Public Health Casebook Publishing.