title: Reducing Periconceptional Methylmercury Exposure: Cost-Utility Analysis for a Proposed Screening Program for Women Planning a Pregnancy in Ontario, Canada.
abstract: BACKGROUND
  The assessment of neurodevelopmental effects in children associated with prenatal methylmercury exposure, from contaminated fish and seafood in the maternal diet, has recently been strengthened by adjustment for the negative confounding resulting from co-exposure to beneficial polyunsaturated fatty acids (PUFAs).
  
  
  OBJECTIVE
  We aimed to determine the cost-effectiveness of a periconceptional screening program of blood mercury concentration for women planning to become pregnant in Ontario, Canada. Fish intake recommendations would be provided for those found to have blood mercury levels above the intervention threshold.
  
  
  METHODS
  Analysis was conducted using a combined decision tree/Markov model to compare the proposed screening intervention with standard care from a societal perspective over a lifetime horizon. We used the national blood mercury distributions of women 20-49 years of age reported in the Canadian Health Measures Survey from 2009 through 2011 to determine the cognitive deficits associated with prenatal methylmercury exposure for successful planned pregnancies. Outcomes modeled included the loss in quality of life and the remedial education costs. Value of information analysis was conducted to assess the underlying uncertainty around the model results and to identify which parameters contribute most to this uncertainty.
  
  
  RESULTS
  The incremental cost per quality-adjusted life year (QALY) gained for the proposed screening intervention was estimated to be Can$18,051, and the expected value for a willingness to pay of Can$50,000/QALY to be Can$0.61.
  
  
  CONCLUSIONS
  Our findings suggest that the proposed periconceptional blood mercury screening program for women planning a pregnancy would be highly cost-effective from a societal perspective. The results of a value of information analysis confirm the robustness of the study's conclusions.
authors.affiliation: Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Gaskin
authors.forename: Colin
authors.initials: C
authors.lastname: Rennie
authors.forename: Doug
authors.initials: D
authors.lastname: Coyle
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D018811:Maternal Exposure / Q000191:economics*; D008431:Maternal-Fetal Exchange; D008767:Methylmercury Compounds / Q000097:blood* / Q000633:toxicity; D008875:Middle Aged; D009864:Ontario; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012073:Remedial Teaching / Q000191:economics; D035501:Uncertainty
chemical_list: D008767:Methylmercury Compounds