Prenatal aneuploidy screening in a low-risk Hispanic population: price elasticity and cost-effectivenessAJOG Global Reports at a Glance

Caitlin M. Clifford, MD; Neil Askew, MS; Diane Smith, MD; Jesus Iniguez, MD; Andrew Smith, MD; Michael D. House, MD; Ashley A. Leech, PhD, MS

AJOG Global Reports (Feb 2024)

Prenatal aneuploidy screening in a low-risk Hispanic population: price elasticity and cost-effectivenessAJOG Global Reports at a Glance

Caitlin M. Clifford, MD,
Neil Askew, MS,
Diane Smith, MD,
Jesus Iniguez, MD,
Andrew Smith, MD,
Michael D. House, MD,
Ashley A. Leech, PhD, MS

Affiliations

Caitlin M. Clifford, MD: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA (Dr Clifford); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Drs Clifford and House); Corresponding author: Caitlin M. Clifford, MD.
Neil Askew, MS: Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN (Mr Askew and Dr Leech)
Diane Smith, MD: Greater Lawrence Family Health Center, Lawrence, MA (Drs Smith and Iniquez)
Jesus Iniguez, MD: Greater Lawrence Family Health Center, Lawrence, MA (Drs Smith and Iniquez); Department of Family Medicine, University of Washington, Seattle, WA (Dr Iniquez).
Andrew Smith, MD: Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN (Drs Smith and Leech)
Michael D. House, MD: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Drs Clifford and House)
Ashley A. Leech, PhD, MS: Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN (Mr Askew and Dr Leech); Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN (Drs Smith and Leech)

Journal volume & issue: Vol. 4, no. 1
p. 100293

Abstract

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BACKGROUND: In October 2015, the Massachusetts Medicaid program temporarily stopped reimbursement for procedures in which the International Classification of Diseases, Tenth Edition, code for serum aneuploidy screening used by certain communities was stipulated. This change led to a substantial number of patients who went without aneuploidy screening for approximately 3 years. OBJECTIVE: This study aimed to determine the change in use and cost-effectiveness of prenatal aneuploidy serum screening in a low-risk Hispanic Medicaid population in Massachusetts. STUDY DESIGN: We conducted a retrospective chart review of Spanish-speaking pregnant patients younger than 35 years of age who underwent aneuploidy serum screening at a Massachusetts community health center. The study compared the aneuploidy serum screening rates for the periods before and after May 2016 when the Massachusetts Medicaid program, MassHealth, temporarily discontinued reimbursement for the screening. Based on these rates, we developed a Markov cohort simulation model to assess the economic value of reimbursed aneuploidy screening vs nonreimbursed or limited screening. Clinical outcomes included trisomy 21, live births, and therapeutic abortions for a trisomy 21 diagnosis. Economic outcomes included discounted quality-adjusted life years and lifetime medical costs, net health benefit, and incremental cost-effectiveness ratios. RESULTS: Before the MassHealth policy change, 69% (55/80) of pregnant individuals selected quad or sequential screens in comparison with only 9% (10/112) who selected screens after the policy change. Traditional aneuploidy serum screening in a low-risk (aged <35 years) Hispanic population was considered to be cost-saving (ie, led to lower incremental costs and higher incremental benefits when compared with nonreimbursed or limited screening). CONCLUSION: From a United States healthcare payer perspective, aneuploidy serum screening for Hispanic pregnant individuals under 35 years of age is economically advantageous when compared with limited screening.

Published in AJOG Global Reports

ISSN: 2666-5778 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Gynecology and obstetrics
Website: https://www.journals.elsevier.com/ajog-global-reports

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