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Obstetrics & Gynecology 2004;103:539-545
© 2004 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Assessment of Demand for Prenatal Diagnostic Testing Using Willingness to Pay

Aaron B. Caughey, MD, MPP, A. Eugene Washington, MD, MSc, Virginia Gildengorin, PhD and Miriam Kuppermann, PhD, MPH

From the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco; Division of Health Services and Policy Analysis, University of California, Berkeley, School of Public Health; and Medical Effectiveness Research Center, University of California, San Francisco.

Address reprint requests to: Dr. Aaron Caughey, Department of Obstetrics, Gynecology, and Reproductive Sciences, 505 Parnasssus Avenue, Box 0132, San Francisco, CA 94143; e-mail: abcmd{at}uclink.berkeley.edu.

OBJECTIVE: To investigate the demand for invasive prenatal diagnostic testing (amniocentesis and chorionic villous sampling) in a racially/ethnically diverse group of pregnant women of all ages in the San Francisco Bay Area by using estimates of willingness to pay for these procedures.

METHODS: We surveyed 447 women of varying ages, ethnicity, and socioeconomic levels to assess their desire to undergo and willingness to pay for invasive prenatal testing for chromosomal disorders. Each woman was asked what she would be willing to pay for invasive diagnostic testing up to the full cost of the procedure. We also asked several demographic and attitudinal questions.

RESULTS: Overall, 49% of the women indicated an interest in undergoing invasive prenatal diagnostic testing. Women aged 35 years and older were more likely to desire testing as compared with women aged less than 35 years (72% versus 36%, P < .001). Of the women aged less than 35 years who desired testing, 31% indicated that they would be willing to pay the full price of $1,300, whereas 73% were willing to pay a portion of the cost. Maternal age of 35 years or greater (odds ratio [OR] 3.3; 95% confidence interval [CI] 2.0, 5.6) and willingness to have an elective abortion (OR 2.8; 95% CI 1.6, 4.9) were significant predictors of desire to undergo prenatal diagnostic testing after controlling for income, race/ethnicity, and education. Maternal age of 35 years or greater (OR 3.5; 95% CI 1.59, 7.88) and having an income greater than $35,000 (OR 2.3; 95% CI 1.02, 5.26) were significant predictors of willingness to pay the full price of testing.

CONCLUSION: A substantial proportion of women of all ages indicate a desire to undergo and a willingness to pay for prenatal diagnostic testing. Variations in willingness to pay are correlated with both socioeconomic and attitudinal differences in addition to age. Guidelines regarding use of prenatal genetic diagnosis should be expanded to offer testing to all women, not just those deemed at increased risk.

LEVEL OF EVIDENCE: II-2






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