Ethics and economics: the case of prenatal technologies. HTA for evidence-based public health

Introduction During last years new prenatal diagnostic technology were developed, and the wider availability of services put up new economics and ethic questions on what are the more appropriate technologies to use. Objective This research aim to evaluate the cost-effectiveness ratio of different prenatal diagnostic technologies, in particular comparing invasive techniques (e.g. amniocentesis) and non invasive techniques (e.g. nuchal translucency), in Italian context, analysing also the ethical aspects associated. Materials and methods Data on different techniques analysed come from a literature review (Medline and other search engine on Internet) and from interview of clinicians of an Italian hospital The economic evaluation was based on a cost-effectiveness analysis, with cost per genetic disease diagnosed. The societal viewpoint was assumed. Results The amniocentesis, carried out on women more than 35 years old as from Italian recommendations, has a cost-effectiveness ratio of 13.700 euro, the nuchal translucency, in the same age group, has a cost-effectiveness of 7.500 euro, but has less diagnostic accuracy. Nevertheless a complete economic evaluation should consider all the consequence, also risk to interrupt pregnancy due to invasive techniques. The research shows different results depending of which outcome are considered. Furthermore it was developed the topic of ethics of choices associated with prenatal diagnosis, showing as economics and ethics could reach the same results, improving the strength of recommendation, with the condition to maintain the value-person measured as diagnostic/therapeutic benefit. Conclusion Both economics and ethics represent a tool to improve the health resource allocation, without penalize the effectiveness