Genetic screening for reproductive planning: methodological and conceptual issues in policy analysis

• Published in: American journal of public health (1971) Vol. 86; no. 5; pp. 684 - 690
• Main Authors: Asch, D A, Hershey, J C, Pauly, M V, Patton, J P, Jedrziewski, M K, Mennuti, M T
• Format: Journal Article
• Language: English
• Published: Washington, DC Am Public Health Assoc 01-05-1996; American Public Health Association
• Subjects: Bioethics; Biological and medical sciences; Cost analysis; Cost effective analysis; Cystic fibrosis; Cystic Fibrosis - diagnosis; Cystic Fibrosis - genetics; Decision Support Techniques; Diagnostic tests; Effectiveness; Female; Fetuses; Genetic Carrier Screening; Genetic counseling; Genetic screening; Genetic Testing - economics; Genetic Testing - methods; Genetics; Health Policy; Humans; Male; Medical sciences; Medical screening; Medical technology; Models, Genetic; Mutation; Pregnancy; Pregnant Women; Prenatal Diagnosis; Prevention and actions; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reproduction; Specific populations (family, woman, child, elderly...); USA; Human; Respiratory disease; Parent; Metabolic diseases; Cystic fibrosis; Decision analysis; Medical screening; Genetic disease; Prenatal; Health economy; Digestive diseases; Strategy; Public health; Pancreatic disease; Cost efficiency analysis; Genetics and Reproduction
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.86.5.684

This paper explores several critical assumptions and methodological issues arising in cost-effectiveness analyses of genetic screening strategies in the reproductive setting.
Seven issues that arose in the development of a decision analysis of alternative strategies for cystic fibrosis carrier screening are discussed. Each of these issues required a choice in technique.
The presentations of these analyses frequently mask underlying assumptions and methodological choices. Often there is no best choice. In the case of genetic screening in the reproductive setting, these underlying issues often touch on deeply felt human values.
Space limitations for published papers often preclude explaining such choices in detail; yet these decisions determine the way the results should be interpreted. Those who develop these analyses need to make sure that the implications of important assumptions are understood by the clinicians who will use them. At the same time, clinicians need to enhance their understanding of what these models truly mean and how they address underlying clinical, ethical, and economic issues.