Pregnant women's and policymakers' preferences for the expansion of noninvasive prenatal screening: A discrete choice experiment approach study.

Background and Aims: Quantitative approaches for eliciting preferences for new interventions are mostly conducted by patients and rarely by policymakers. This study aimed to quantify the preferences of pregnant women and policymakers regarding the addition of a new test to prenatal screening programs for detecting chromosomal abnormalities. Methods: A discrete choice experiment was conducted to measure the respondents' preferences for a new prenatal test. A seven-attribute instrument was built based on interviews with pregnant women and policymakers. The data were analyzed using robust conditional logistic regression and nested logit models. Results: In total, 272 pregnant women and 24 policymakers completed the questionnaire (response rates of 48% and 55%, respectively). Overall, all attributes were statistically significant in the pregnant women group, whereas only three attributes (test performance, degree of test result certainty, and cost) were statistically significant in the policymakers group. Statistically significant differences in test performance and information were observed between the two groups. Conclusion: Policymakers differed from pregnant women in their appraisal of attributes related to their preference for a new prenatal screening intervention. The low response rates observed in both groups suggest that further investigation of the relevance of this approach must be conducted.

Expansion of non-invasive prenatal screening to the screening of 10 types of chromosomal anomalies: a cost-effectiveness analysis.

OBJECTIVES: To determine the cost-effectiveness of the addition of chromosomal anomalies detectable by non-invasive prenatal screening (NIPS), in a prenatal screening programme targeting common aneuploidies. DESIGN, SETTING AND PARTICIPANTS: A simulation study was conducted to study the addition of chromosomal anomalies detectable by NIPS (sex chromosome aneuploidies, 22q11.2 deletion syndrome, large deletion/duplication >7 Mb and rare autosomal trisomies) to five basic strategies currently aiming the common trisomies: three strategies currently offered by the public healthcare systems in Canada, whose first-tier test is performed with biochemical markers, and two programmes whose first-tier test consists of NIPS-based methods. OUTCOME MEASURES: The total number of cases of chromosomal anomalies detected and the costs related to the consumption of medical services. RESULTS: The most effective and the most cost-effective option in almost all prenatal screening strategies is the option that includes all targeted additional conditions. In the strategies where NIPS is used as first-tier testing, the cost per additional case detected by adding all possible additional anomalies to a programme that currently targets only common trisomies is $C25 710 (95% CI $C25 489 to $C25 934) for massively parallel shotgun sequencing and $C57 711 (95% CI $C57 141 to $C58 292) for targeted massively parallel sequencing, respectively. The acceptability curves show that at a willingness-to-pay of $C50 000 per one additional case detected, the expansion of NIPS-based methods for the detection of all possible additional conditions has a 90% probability of being cost-effective. CONCLUSION: From an economic perspective, in strategies that use NIPS as a first-tier screening test, expanding the programmes to detect any considered chromosomal anomalies other than the three common trisomies would be cost-effective. However, the potential expansion of prenatal screening programmes also requires consideration of societal issues, including ethical ones.

Development of a discrete choice experiment questionnaire to elicit preferences by pregnant women and policymakers for the expansion of non-invasive prenatal screening.

OBJECTIVE: An instrument for measuring intervention preferences applicable to both patients and policymakers would make it possible to better confront the needs of the supply and demand sides of the health care system. This study aimed to develop a discrete choice experiments (DCE) questionnaire to elicit the preferences of patients and policymakers. The instrument was specifically developed to estimate preferences for new conditions to be added to a screening program for fetal chromosomal anomalies. METHODS: A DCE development study was conducted. The methods employed included a literature review, a qualitative study (based on individual semi-structured interviews, consultations, and a focus group discussion) with pregnant women and policymakers, and a pilot project with 33 pregnant women to validate the first version of the instrument and test the feasibility of its administration. RESULTS: An initial list of 10 attributes was built based on a literature review and the qualitative research components of the study. Five attributes were built based on the responses provided by the participants from both groups. Eight attributes were consensually retained. A pilot project performed on 33 pregnant women led to a final instrument containing seven attributes: 'conditions to be screened', 'test performance', 'moment at gestational age to obtain the test result', 'degree of test result certainty to the severity of the disability', 'test sufficiency', 'information provided from test result', and 'cost related to the test'. CONCLUSION: It is possible to reach a consensus on the construction of a DCE instrument intended to be administered to pregnant women and policymakers. However, complete validation of the consensual instrument is limited because there are too few voting members of health technology assessment agencies committees to statistically ascertain the relevance of the attributes and their levels.

Survey of the seroprovalence of HTLV I/II in hemodialysis patients and blood donors in Urmia.

Human T lymphocytotropic virus HTLV is a virus from retroviridae family, and more than 20 million people are infected with this virus worldwide. It can cause leukemia/lymphoma in adults, tropical spastic paralysis, HTLV associated myelopathy, spastic paraparesis, tropical myelopathy (HAM/TSP), and some other nervous system diseases. It is transmitted by means of blood products via blood transfusion. In Iran, except the Great Khorasan region, none of blood products undergo screening for HTLV. Immunodeficiency in HD patients, results in increased risk of infection. The aim of this study was to determine the prevalence of anti-HTLV-I/II antibody among hemo-dialysis patients and healthy blood donors in Urmia, Iran. A cross-sectional study was conducted from April 2005 to January 2006 among healthy blood donors and in 2006 among hemodialysis patients. The serum of 2046 blood donors and 95 Hemodialysis patients was checked with enzyme-linked immunosorbent assay (ELISA) for anti HTLV-I/II, and positive cases were confirmed by western blot. Three seropositive cases among 95 hemodialysis patients were detected, and only one of them was confirmed by western blot. Of the healthy blood donors 1910 (93.4%) were males and 136 (6.6%) were females. Serum of 1997 (97.6%) subjects was negative, and 49 (2.6%) cases were positive for HTLV by ELISA. Among the positive cases western blot confirmed only 7 (14.3%) persons as HTLV positive, 37 (75.5%) as negative, and 5 (10.2%) as indeterminate. Among the 7 positive cases 6 (85.6%) were infected with HTLV-I, and only one (14.3%) with HTLV-I /II infection. Total Serologic prevalence of HTLV in healthy blood donors was 0.34%. We conclude that such high serologic prevalence in the population of blood donors in Urmia city, suggests the high probability of transmission through blood transfusion, and therefore screening of blood donors for human T-lymphocyte virus is essential in this region. HD patients should be screened for HTLV and positive subjects should be isolated.