GENETIC SCREENING FOR REPRODUCTIVE PLANNING - METHODOLOGICAL AND CONCEPTUAL ISSUES IN POLICY ANALYSIS

Objectives, This paper explores several critical assumptions and metho dological issues arising in cost-effectiveness analyses of genetic scr eening strategies in the reproductive setting. Methods. Seven issues t hat arose in the development of a decision analysis of alternative str ategies for cystic fibrosis carrier screening are discussed. Each of t hese issues required a choice in technique. Results, The presentations of these analyses frequently mask underlying assumptions and methodol ogical choices. Often there is no best choice. In the case of genetic screening in the reproductive setting, these underlying issues often t ouch on deeply felt human values. Conclusions. Space limitations for p ublished papers often preclude explaining such choices in detail; yet these decisions determine the way the results should be interpreted. T hose who develop these analyses need to make sure that the implication s of important assumptions are understood by the clinicians who will u se them. At the same time, clinicians need to enhance their understand ing of what these models truly mean and how they address underlying cl inical, ethical, and economic issues.