title: Genetic screening for reproductive planning: methodological and conceptual issues in policy analysis.
abstract: OBJECTIVE
  This paper explores several critical assumptions and methodological issues arising in cost-effectiveness analyses of genetic screening strategies in the reproductive setting.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Internal Medicine, VA Medical Center, Philadelphia, PA 19104-2676, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Asch
authors.forename: J C
authors.initials: JC
authors.lastname: Hershey
authors.forename: M V
authors.initials: MV
authors.lastname: Pauly
authors.forename: J P
authors.initials: JP
authors.lastname: Patton
authors.forename: M K
authors.initials: MK
authors.lastname: Jedrziewski
authors.forename: M T
authors.initials: MT
authors.lastname: Mennuti
mesh_terms: D003550:Cystic Fibrosis / Q000175:diagnosis / Q000235:genetics*; D003661:Decision Support Techniques; D005260:Female; D006580:Genetic Carrier Screening; D005820:Genetic Testing / Q000191:economics / Q000379:methods; D006291:Health Policy; D006801:Humans; D008297:Male; D008957:Models, Genetic; D011247:Pregnancy; D037841:Pregnant People; D011296:Prenatal Diagnosis