A cost-benefit analysis of preimplantation genetic diagnosis for carrier couples of cystic fibrosis.

摘要

OBJECTIVE: To perform a cost-benefit analysis of preimplantation genetic diagnosis (PGD) for carrier couples of cystic fibrosis (CF) compared with the alternative of natural conception (NC) followed by prenatal testing and termination of affected pregnancies. DESIGN: Cost-benefit analysis using a decision analytic model. SETTING: Outpatient reproductive health practices. PATIENT(S): A simulated cohort of 1,000 female patients. INTERVENTION(S): We calculated the net benefit of giving birth to a child as the present value of lifetime earnings minus lifetime medical costs. MAIN OUTCOME MEASURE(S): Net benefits in dollars. RESULT(S): When used for women younger than 35 years of age, the net benefit of PGD over NC was Dollars 182,000 (Dollars 715,000 vs. Dollars 532,000, respectively). For women aged 35-40 years, the net benefit of PGD over NC was Dollars 114,000 (Dollars 634,000 vs. Dollars 520,000, respectively). For women older than 40 years, however, the net benefit of PGD over NC was -Dollars 148,000 (Dollars 302,000 vs. Dollars 450,000, respectively). CONCLUSION(S): Preimplantation genetic diagnosis provides net economic benefits when used by carrier couples of CF. Although there is an upper limit of maternal age at which economic benefit can be demonstrated, carrier couples of CF should be offered PGD for prevention of an affected child.