Targeting Precision Medicine: Evidence from Prenatal Screening

About this event

Technological advances in medicine increasingly offer opportunities to target care to patients identified through screening, raising questions of how broadly to screen for potential cases of disease. We explore this trade-off empirically in the context of a new, non-invasive prenatal screening (cfDNA). cfDNA screening is used to target a followup, invasive test which is twice as costly and elevates the risk of miscarriage. Using Swedish administrative data on prenatal choices for pregnancies conceived between 2011 and 2019 – a period in which Swedish regions began providing coverage for the new screening – we document that cfDNA coverage has enormous effects both on increasing cfDNA screening and on reducing rates of invasive testing. To assess the impact of counterfactual targeting of cfDNA coverage, we develop and estimate a stylized model of prenatal choices. We find that narrow targeting of coverage for screening has the (rare) potential to 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.