Præimplantationsdiagnostik - Sundhedsstyrelsen

25% had PND as a preference. It is not surprising that the attitude among
families with a risk for haemophilia was different in this aspect. Data from
the Danish Cytogenetic Central Register show that couples with a risk for
haemophilia mostly abstain from legal abortion if a foetus with haemophilia
is diagnosed by PND. Accordingly, the present study revealed that
in families with a risk for haemophilia, PGD by sex selection is a much
less attractive alternative than PND. Moreover, many of the families with
haemophilia did not want any diagnostic testing, but preferred to take the
risk of a diseased child. Based on these data, the questionnaire survey
seem to provide a strong indication that PGD is preferred by couples with
a risk of having a child with a severe hereditary disease, whereas couples
with a risk for less severe diseases either choose PND as their first choice
or abstain from any kind of diagnostic testing.
The choice of the potential users is in good accordance with a weighty ethical
argument for PGD being that a group of couples at risk of having a
sick child can have a child without that specific disease without an ethically
problematic intervention such as legal abortion. Against this are two
ethical arguments against PGD, namely a possible long-term risk for the
foetus since the safety of the PGD procedure is not fully evaluated, and
secondly that a problem exists with respect to the justice in the prioritysetting
of the resources within the health care sector.
The economy
In order to elucidate the issue of justice and the question of priority-setting
a health economic analysis was carried out as part of this HTA. However,
the analysis was only performed for a single hereditary disease – cystic
fibrosis (CF). The analysis showed that the expected health care costs for a
couple with a risk of having a child with CF choosing up to three PGD
cycles, is DKK 112,390 compared with DKK 78,608 for the PND alternative.
In this analysis was included, the life time costs for the health care
sector of a child born with CF. This means that each couple that choose to
have PGD instead of PND implies an extra cost for the health care sector
of DKK 33,782 due to the higher costs of PGD. Excluding the lifetime
costs of CF the difference between PGD and PND is increased to DKK
89,338.
If PGD is introduced as an alternative to PND it is estimated that around
57 couples per year will choose PGD. For 30 of these couples where the
indication for PGD is a translocation, the cost for IVF will be ”saved” as
they are already eligible to IVF due to infertility. Totally, this means that
the extra cost for the Danish health care sector for the treatment of all 57
couples with PGD – using cystic fibrosis as a model – is expected to be in
the order of 1.5 million DKK per year or 4.7 million DKK, if the saved
future life time costs of CF are not included. If one delivery of a child with
cystic fibrosis is avoided, then 2.9 million DKK to medicine, treatment,
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