Impact of prenatal screening on future resource utilization in pregnancy

Metcalfe, Amy Lynn

Impact of prenatal screening on future resource utilization in pregnancy

atmire.migration.oldid	359
dc.contributor.advisor	Tough, Suzanne
dc.contributor.author	Metcalfe, Amy Lynn
dc.date.accessioned	2012-09-26T18:20:45Z
dc.date.available	2014-09-27T07:00:14Z
dc.date.issued	2012-09-26
dc.date.submitted	2012	en
dc.description.abstract	In 2007, the Society of Obstetricians and Gynaecologists of Canada first recommended that prenatal screening for fetal aneuploidy be offered to all pregnant women. This is an important change in clinical obstetrics as previously these services had only been routinely offered to women who would be 35 or older at the time of delivery; however, maternal age alone is a poor predictor of fetal aneuploidy. Obtaining reliable data on prenatal screening utilization is problematic in Canada as these data are not collected in a systematic way nationally and, in many cases, not even provincially. This study aimed to understand utilization of prenatal screening in an Albertan context; to examine the impact of different prenatal screening strategies on health care utilization in pregnancy; and to estimate the incremental cost of prenatal screening when accounting for all of direct medical costs of this procedure including ancillary service use. Data on health resource utilization that occurred in the three months prior to pregnancy, during pregnancy and three months post-partum were collected from twelve unique clinical and administrative databases. Using deterministic linkage, participants from multiple databases were linked based on personal health number, gender and date of birth. This study found that utilization of prenatal screening tends to impact utilization of prenatal diagnostic services but not overall health resource utilization, and that there is a cost for prenatal screening but this cost may be less than what is suggested in the literature due to differences between hypothetical utilization patterns and actual resource utilization. It also suggests that current techniques used to identify women who have an increased risk of carrying a fetus with aneuploidy, may also be useful for identifying women who are at an increased risk of a variety of adverse pregnancy outcomes. With the rapid development of non-invasive prenatal testing, additional clinical changes in prenatal screening and diagnosis are likely to occur in the next few years. However, prior to abandoning screening in favour of non-invasive prenatal testing, the results of this work suggest that a more thorough evaluation of the impact of prenatal screening on non-aneuploidy outcomes may be warranted.	en_US
dc.description.embargoterms	2 years	en_US
dc.identifier.citation	Metcalfe, A. L. (2012). Impact of prenatal screening on future resource utilization in pregnancy (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/26463	en_US
dc.identifier.doi	http://dx.doi.org/10.11575/PRISM/26463
dc.identifier.uri	http://hdl.handle.net/11023/228
dc.language.iso	eng
dc.publisher.faculty	Graduate Studies
dc.publisher.institution	University of Calgary	en
dc.publisher.place	Calgary	en
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subject	Epidemiology
dc.subject.classification	prenatal screening	en_US
dc.subject.classification	prenatal diagnosis	en_US
dc.subject.classification	Pregnancy	en_US
dc.title	Impact of prenatal screening on future resource utilization in pregnancy
dc.type	doctoral thesis
thesis.degree.discipline	Community Health Sciences
thesis.degree.grantor	University of Calgary
thesis.degree.name	Doctor of Philosophy (PhD)
ucalgary.item.requestcopy	true