Prenatal aneuploidy screening in a low-risk Hispanic population: price elasticity and cost-effectiveness

Abstract

Background: In October 2015, the Massachusetts Medicaid program temporarily stopped reimbursement for procedures in which the International Classification of Diseases, Tenth Edition, code for serum aneuploidy screening used by certain communities was stipulated. This change led to a substantial number of patients who went without aneuploidy screening for approximately 3 years.

Objective: This study aimed to determine the change in use and cost-effectiveness of prenatal aneuploidy serum screening in a low-risk Hispanic Medicaid population in Massachusetts.

Study design: We conducted a retrospective chart review of Spanish-speaking pregnant patients younger than 35 years of age who underwent aneuploidy serum screening at a Massachusetts community health center. The study compared the aneuploidy serum screening rates for the periods before and after May 2016 when the Massachusetts Medicaid program, MassHealth, temporarily discontinued reimbursement for the screening. Based on these rates, we developed a Markov cohort simulation model to assess the economic value of reimbursed aneuploidy screening vs nonreimbursed or limited screening. Clinical outcomes included trisomy 21, live births, and therapeutic abortions for a trisomy 21 diagnosis. Economic outcomes included discounted quality-adjusted life years and lifetime medical costs, net health benefit, and incremental cost-effectiveness ratios.

Results: Before the MassHealth policy change, 69% (55/80) of pregnant individuals selected quad or sequential screens in comparison with only 9% (10/112) who selected screens after the policy change. Traditional aneuploidy serum screening in a low-risk (aged <35 years) Hispanic population was considered to be cost-saving (ie, led to lower incremental costs and higher incremental benefits when compared with nonreimbursed or limited screening).

Conclusion: From a United States healthcare payer perspective, aneuploidy serum screening for Hispanic pregnant individuals under 35 years of age is economically advantageous when compared with limited screening.

Keywords: ICD-10; Medicaid; aneuploidy screening; community health center; cost-effectiveness; low-risk pregnancy; price elasticity; public payer; serum screening; trisomy 21.

Figure 1

Sensitivity analysis of the incremental effectiveness of screening The horizontal axis displays the incremental effectiveness of screening when compared with limited screening. The vertical axis displays the maternal age groups that were evaluated. Combinations of varied trisomy 21 utility values and applied duration of the utility values were plotted. The base case analysis included the utility value of 0.645 applied to the mother's life years for 18 years. TAB, therapeutic abortion; T21, trisomy 21.

Figure 2

Probabilistic cost-effectiveness plane for screening vs limited screening in 25-year-olds, 18-year-olds, and 34-year-olds The horizontal axis displays incremental quality-adjusted life years. The vertical axis displays incremental costs in 2020 US dollars. Simulated incremental cost-effectiveness ratios were potted and were all cost-saving. T21, trisomy 21.

Figure 3

Incremental cost savings of screening in comparison with limited screening based on probability of therapeutic abortion for a trisomy 21 diagnosis TAB probability for a T21 diagnosis was varied from 30-13%. ICER, incremental cost-effectiveness ratio; TAB, therapeutic abortion.