Cost-effectiveness analysis of carrier and prenatal genetic testing for X-linked hemophilia.
OBJECTIVE
Hemophilia involves a lifelong burden from the perspective of the patient and the entire healthcare system. Advances in genetic testing provide valuable information to hemophilia-affected families for family planning. The aim of this study was to analyze the cost-effectiveness of carrier and prenatal genetic testing in the health-economic framework in Taiwan.


METHODS
A questionnaire was developed to assess the attitudes towards genetic testing for hemophilia. We modeled clinical outcomes of the proposed testing scheme by using the decision tree method. Incremental cost-effectiveness analysis was conducted, based on data from the National Health Insurance (NHI) database and a questionnaire survey.


RESULTS
From the NHI database, 1111 hemophilic patients were identified and required an average medical expenditure of approximately New Taiwan (NT) $2.1 million per patient-year in 2009. By using the decision tree model, we estimated that 26 potential carriers need to be tested to prevent one case of hemophilia. At a screening rate of 79%, carrier and prenatal genetic testing would cost NT $85.9 million, which would be offset by an incremental saving of NT $203 million per year by preventing 96 cases of hemophilia. Assuming that the life expectancy for hemophilic patients is 70 years, genetic testing could further save NT $14.2 billion. Higher screening rates would increase the savings for healthcare resources.


CONCLUSIONS
Carrier and prenatal genetic testing for hemophilia is a cost-effective investment in healthcare allocation. A case management system should be integrated in the current practice to facilitate patient care (e.g., collecting family pedigrees and providing genetic counseling).
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Meng-Che
MC
Tsai
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Chao-Neng
CN
Cheng
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Ru-Jay
RJ
Wang
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Kow-Tong
KT
Chen
Department of Pediatrics, Chi-Mei Hospital, Tainan, Taiwan.
Mei-Chin
MC
Kuo
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pediatrics, Chi-Mei Hospital, Tainan, Taiwan. Electronic address: shiojean@gmail.com.
Shio-Jean
SJ
Lin
D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D005820:Genetic Testing / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006467:Hemophilia A / Q000175:diagnosis*; D006579:Heterozygote; D006801:Humans; D009313:National Health Programs; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics*; D011795:Surveys and Questionnaires; D013624:Taiwan
carrier testing; economic analysis; ethics; hemophilia; prenatal diagnosis