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精准医疗的定向实施:来自产前筛查的证据

Targeting Precision Medicine: Evidence from Prenatal Screening
Journal of Political Economy · 2024 · Peter Conner、Liran Einav、Amy Finkelstein、Petra Persson

中文摘要

我们研究一种无创产前筛查——游离DNA(cfDNA)筛查——的引入;该筛查用于定向安排一种成本更高、且会提高流产风险的侵入性检查。利用瑞典行政数据,我们发现,对cfDNA筛查的费用覆盖实质性地增加了cfDNA筛查的使用,并减少了侵入性检查。我们构建并估计了一个关于产前选择的简化模型,发现对cfDNA费用覆盖进行窄范围定向可以改善结果并降低成本,而更广泛的费用覆盖也能改善结果,但会增加成本。这些发现表明,设计良好的筛查定向机制具有潜在收益,同时也凸显了定向设计本身的重要性。

Abstract

We study the introduction of a noninvasive prenatal screening—cell-free DNA (cfDNA) screening—which is used to target a more costly invasive test that elevates miscarriage risk. Using Swedish administrative data, we document that coverage of cfDNA substantially increases cfDNA screening and reduces invasive testing. We develop and estimate a stylized model of prenatal choices and find that narrow targeting of cfDNA coverage can improve outcomes and reduce costs, while broader coverage also improves outcomes but with increased costs. These findings point to the potential gains from well-designed targeting of screening but at the same time highlight the importance of the targeting design.
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