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

Abstract

(1) To determine the price elasticity of prenatal aneuploidy screening in a Hispanic population less than 35 years old insured through MassHealth (MH), a Medicaid program in MA; and (2) to assess the cost-effectiveness of screening, when screening cost is reimbursed vs. not reimbursed in this population. We conducted a retrospective chart review to determine screening rates at a community health center outside of Boston, MA before and after the summer of 2016 when MH discontinued aneuploidy screening reimbursement for low-risk women. We examined the charts of all Spanish speaking pregnant patients less than 35 years old initiating care in September and October 2015 and 2017 to determine screening rates with a quad or sequential screen. We created a decision analytic Markov model to follow two cohorts of 10,000 low-risk Hispanic women, one with reimbursed screening and one without, through pregnancy, birth, and remainder of their life expectancy. In each cohort, maternal age was varied to include 18, 25, and 34-year-olds. See Table 1 for model inputs. Clinical outcomes included trisomy 21 (T21) livebirths and therapeutic abortions (TABs) for a T21 diagnosis. Economic outcomes included the incremental cost of the non-reimbursed strategy, incremental effectiveness of the reimbursed strategy, and combined incremental cost-effectiveness ratio (ICER). In September and October 2015 and 2017, screening rates at the health center were 69% and 9%, respectively. Cost savings totaled $2.62 per 34-year-old screened with an incremental effectiveness of 0.000043 quality-adjusted life-years corresponding to 23 minutes of life. See Table 2 for additional age group results. Aneuploidy screening rates in this population were strongly influenced by cost changes. In all modeled cohorts, reimbursement of screening was cost saving, i.e. associated with lower incremental costs and higher utilities than non-reimbursement. Given the cost saving status, it is counterproductive for a payer to not provide reimbursement for aneuploidy screening in Hispanic women less than 35 years of age.View Large Image Figure ViewerDownload Hi-res image Download (PPT)