Prospects for the inclusion of the preimplantation genetic diagnosis procedure in the compulsory health insurance program taking into account the cost characteristics and foreign experience

Abstract

Objectives. The purpose of this study is to determine the prospects for the inclusion of the preimplantation genetic diagnosis (PGD) procedure in the compulsory health insurance (CHI) program, taking into account the cost characteristics of the procedure and the existing foreign experience in this field. Material. The regulatory legal acts, the practice of the use of PGD in Russia, UK, Germany, Israel, Netherlands, and USA are studied. Methods used: general philosophical, general scientific, private scientific (statistical, mathematical and financial analysis, factor analysis method), special (structural-legal, comparativelegal, formal-legal). Results. The prospects for the inclusion of the PGD procedure in the compulsory medical insurance program are determined taking into account the cost characteristics of the procedure and the existing foreign experience in this field. It has been established that the total cost of PGD during IVF as part of infertility treatment consists mainly of the costs of the basic stages of IVF — among the total costs, the cost of IVF cycles in this case is about 75%, while the cost of the study itself is about 20%, additional services and research — 5%. In other cases, the main factors affecting the total cost of PGD will be the cost of embryo biopsy (about 25%), molecular genetic research using the chosen method (about 70%), preliminary and subsequent genetic counseling (about 5%). It has been proved that in order to provide normative support for such a step, it seems necessary to differentiate the grounds for free PGD depending on the goals of diagnosis and research methods in each case. Couples undergoing infertility treatment should be given the right to include such diagnostics in the package of services available within a limited number of free cycles. The decision to conduct PGD should be made solely on the basis of the results of medical genetic counseling and be completely voluntary. Conclusions. The inclusion of the cost of PGD in the CHI programs to assess the risks of developing genetically caused diseases and chromosomal abnormalities in fertile couples should be based on the development of a single list of the most common genetically determined disorders, for which PGD can be performed free of charge. In this case, each disease or chromosomal abnormality in the list should correspond to a specific research method.