Decision analysis of prenatal testing for chromosomal disorders: What do the preferences of pregnant women tell us?

被引:18
作者
Harris, RA
Washington, AE
Feeny, D
Kuppermann, M
机构
[1] Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, Sch Med, San Francisco, CA 94143 USA
[2] Univ Calif, Med Effectiveness Res Ctr, San Francisco, CA 94143 USA
[3] Univ Calif San Francisco, Sch Med, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA
[4] Univ Alberta, Inst Hlth Econ, Edmonton, AB T5J 3N4, Canada
来源
GENETIC TESTING | 2001年 / 5卷 / 01期
关键词
D O I
10.1089/109065701750168644
中图分类号
Q3 [遗传学];
学科分类号
071007 ; 090102 ;
摘要
Current guidelines recommend offering invasive testing for chromosomal disorders only to women who are aged 35 or older, or who are at similarly elevated risk (as determined by maternal serum and/or ultrasonographic screening). We conducted a decision analysis, using preference scores obtained from pregnant women, to determine whether current guidelines maximize the health-related quality of life of these women. If only miscarriage and chromosomal abnormalities are considered, the expected value of testing exceeds that of not testing for women 30 years of age or older. However, if a comprehensive range of relevant testing outcomes is considered, testing offers a higher expected value than not testing, regardless of age. Furthermore, patient preferences for specific testing outcomes play a much more substantial role in determining the course of action with the highest expected value than does the probability of any of the possible testing outcomes. The current age- and risk-based guideline for prenatal diagnosis does not maximize expected value and fails to appropriately consider individual patient preferences. For counseling purposes, how an individual values the presence and timing of fetal chromosomal information should be carefully understood.
引用
收藏
页码:23 / 32
页数:10
相关论文
共 37 条
[1]  
*AM COLL OBST GYN, 1987, ANT DIAGN GEN DIS
[2]  
[Anonymous], 1988, CLIN CHEM
[3]  
[Anonymous], 1996, GUID CLIN PREV SERV
[4]  
BRANDENBURG H, 1992, CLIN GENET, V42, P149
[5]   REPRODUCTIVE-BEHAVIOR AND PRENATAL-DIAGNOSIS FOLLOWING GENETIC TERMINATION OF PREGNANCY IN WOMEN OF ADVANCED MATERNAL AGE [J].
BRANDENBURG, H ;
DEKONING, W ;
JAHODA, MGJ ;
STIJNEN, T ;
DERIDDER, MAJ ;
SACHS, ES ;
WLADIMIROFF, JW .
PRENATAL DIAGNOSIS, 1992, 12 (12) :1031-1035
[6]  
Bryce R L, 1989, Paediatr Perinat Epidemiol, V3, P137, DOI 10.1111/j.1365-3016.1989.tb00507.x
[7]  
CONLEY R, 1973, PRENATAL DIAGNOSIS H
[8]  
FEENY D, 1989, MED CARE, V27, P190
[9]   METHODOLOGY FOR MEASURING HEALTH-STATE PREFERENCES .2. SCALING METHODS [J].
FROBERG, DG ;
KANE, RL .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 1989, 42 (05) :459-471
[10]  
GRANT A, 1991, LANCET, V337, P1491