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.
- Understand the role of economic evaluation in health policy decision-making
- Critically appraise the quality of an economic evaluation and evaluate its applicability
- Interpret economic evaluations and use the results to inform policy recommendations
- Discuss the challenges of interpreting cost-effectiveness analysis as compared to cost-utility analysis
- 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
- How should scarce resources be allocated within a publically funded healthcare system?
- What type of economic evaluation was performed (cost-minimization, cost-effectiveness, cost-utility, cost-benefit)?
- How would you appraise the quality of the economic evaluation? Is it adequate for use in policy decision-making?
- 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?
- What recommendations would you make about NIPT screening based on the results of economic evaluation?
- Are there important factors not addressed by the economic evaluation?
- Should the ministry allocate resources to supporting parents of children with Down syndrome?
economic evaluation, cost-effectiveness analysis, genetic screening, Down syndrome.
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.