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A cost/benefit analysis of amniocentesis

Posted in Attitudes to disability, Diagnostic testing by Matt at WelcometoIllinois on September 5, 2008

The New York Times’s Freakonomics column has published an interesting article about “the Economics of Amniocentesis”, discussing a view of the risk/reward of the procedure used to diagnose genetic disorders, including Down’s syndrome.

The article itself is more about the cost/benefit analysis of whether the risks of miscarriage outweigh the benefit of a mother knowing whether her baby has a genetic disorder or not, rather than the financial effects, although the study from 2002 that it refers to also makes a passing comment on the “financial cost to medical payers and to society” of raising a child with a severe genetic disorder.

Ignoring the financial impact (it is barely touched upon in the report) what is interesting is the suggestion that it is illogical to only offer the amniocentesis test to women over 35 since the older a mother-to-be gets, the less likely they are to want to run the risk of the test causing a miscarriage.

As the post states “The economists conjecture that these women may be rationally weighing costs and benefits in a more sophisticated manner than the doctors who are giving them advice… if the amnio causes a miscarriage to a woman in her 20’s or early 30’s, she is very likely to get pregnant again… But a woman in her late 30’s or 40’s may find it difficult to get pregnant again.”

The theoretical cost an amniocentesis to an older woman is therefore higher than it is for a younger woman. The post continues: “If the authors are correct that too many women in their 40’s have been advised to have amnios (because doctors aren’t thinking about the difficulty of replacing a viable fetus with a subsequent pregnancy), then the same logic may suggest that too few younger women are being advised to have amnios (because their docs aren’t thinking about the relative ease with which they can get pregnant again).”

This would appear to support the 2007 recommendation of the American College of Obstetricians and Gynecologists (ACOG) that all pregnant women, regardless of their age, should be offered screening for Down syndrome, as well as the findings of other research reports.

Of course, decisions related to amniocentesis are also personal issues and that beliefs can outweigh any cost/benefit arguments. As the NYT states “The information revealed by an amnio won’t change a committed anti-abortionist’s mind, and hence an amnio has little benefit.”

One of the criticisms I would make of the study is that it appears to assume that having a child with disability represents the same “cost” for all parents. I would argue that this is not the case – clearly in the case of someone with anti-abortion beliefs, but more subtly in families like mine where we came to a decision that it wasn’t such a huge cost after all (although not until after the amnio).

Some people may be thinking that the decision of whether to have an amniocentesis or not is not a matter for economists, and I can understand that, but it is interesting to read a debate on this (the comments to the NYT story are as interesting as the story or the study itself) that does not revolve around beliefs and faith.

However, it is worth remembering that it is not just doctors and parents that may be making use of the data in the study. As ‘Sarah’ points out in the comments:

“There is a world of difference between a couple (or an individual) privately deciding that it wants to test for genetic defects in order to decide whether to go through with a pregnancy and between a third party (whether it’s the government or a doctor or an insurance company) deciding whether a couple must test so that they can terminate the pregnancy if there are defects.”


2 Responses

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  1. […] the research results are accurate they will certainly cast a new light on the decision of expectant mothers to decide whether or not to go through with invasive testing. It will be […]

  2. […] is probably true, but the risk of birth defects should also be factored into any cost/benefit analysis of diagnostic testing. I certainly don’t remember it being mentioned when we were preparing […]

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