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 reimbursing the ICD-10 code used by certain communities for serum aneuploidy screening. This change resulted in a substantial number of patients without aneuploidy screening for approximately three years.Objective: To determine the change in utilization 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 under 35 years of age receiving aneuploidy serum screening at a Massachusetts community health center. The study compared aneuploidy serum screening rates 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 versus non-reimbursed 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, compared to 9% (10/112) post-policy change. Traditional aneuploidy serum screening in a low-risk (aged <35 years) Hispanic population was considered cost-saving (i.e., resulted in lower incremental costs and higher incremental benefits compared to non-reimbursed or limited screening).Conclusions: From a U.S. healthcare payer perspective, aneuploidy serum screening for Hispanic pregnant individuals under 35 years of age is economically advantageous compared to limited screening.