Authors: Amber Salisbury 1 2, Sarah Norris1, Alison Pearce2 3, Kirsten Howard1
Affiliations:
1Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
2The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
3Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
The following is a summary of a research paper by the authors. For more information, please see the published full-text journal article: https://link.springer.com/article/10.1007/s40258-024-00938-5
Prenatal screening involves a combination of tests which assess the risk of chromosomal conditions in a fetus. Non-invasive prenatal testing (NIPT) has been introduced as an alternative to combined first trimester screening (cFTS). NIPT is more accurate in detecting the three common trisomies (Down syndrome, Patau syndrome, and Edwards syndrome) compared to cFTS. NIPT can detect a broader range of conditions, but with lower accuracy than when testing for only the three common trisomies. In Australia, cFTS receives a public subsidy, whereas NIPT predominantly does not. Despite its potential as a valuable genetic screening tool, NIPT faces several challenges including cost, commercial delivery, psychological impacts of the screening process, and limited accessibility in rural and regional communities.
This study conducted a discrete choice experiment (DCE) to explore Australian preference for prenatal screening, comparing metropolitan and rural/regional communities. DCEs analyse choices through online surveys that present participants with hypothetical scenarios. We recruited 160 metropolitan and 168 rural/regional participants across Australia.
We found that while metropolitan preferences were shaped by the accuracy and cost of screening tests, rural/regional preferences were influenced by a broader range of features. Both groups preferred tests with lower false positive rates, false negative rates, and costs. Rural communities additionally preferred tests screening for more conditions, with lower inconclusive rates and shorter wait times. The number of screening tests and revealing the sex of the fetus were not significant within either group. Willingness to pay (WTP) estimates ranged from AU$13 to avoid a test with a 1% increase in the false-positive rate to AU$323 to screen for a wide range of conditions.
This study shows the lower uptake of NIPT in rural/regional communities is not due to these communities placing a lower value on NIPT features, suggesting there is a health service delivery gap that needs to be addressed. This study provides Australian-specific WTP estimates which can be incorporated into economic evaluations and directly inform future decisions around NIPT that explicitly account for Australian preferences.
Source: Unsplash
