Evaluating the use of parental reports to estimate health care resource utilization in children with suspected genetic disorders

Children with genetic conditions in the United States: Prevalence estimates from the 2016-2017 National Survey of Children's Health

PURPOSE

Estimating the overall prevalence of genetic conditions among children in the United States and the burden of these conditions on children and their families has been challenging. The redesigned National Survey of Children's Health provides an opportunity to examine the prevalence and burden.

METHODS

We used the combined 2016-2017 National Survey of Children's Health to estimate the prevalence of genetic conditions among children aged 0 to 17 years (N = 71,522). Bivariate analyses were used to assess differences in sociodemographic characteristics, health-related characteristics, and health care utilization between children with and without genetic conditions.

RESULTS

In 2016-2017, the prevalence of children aged 0 to 17 years with a reported genetic condition was approximately 0.039, roughly equating to 2.8 million children. A greater percentage of children with genetic conditions had a physical (50.9% vs 24.8%), mental (27.9% vs 5.8%), or behavioral/developmental/intellectual condition (55.6% vs 14.4%) than children without a genetic condition. Furthermore, they used more care and had more unmet health needs (7.6% vs 2.9%).

CONCLUSION

This study provides an estimate of the overall prevalence of children living with genetic conditions in the United States based on a nationally representative sample. It also highlights the physical, mental, and behavioral health needs among children with genetic conditions and their unmet health care needs.

Self-reported infertility diagnoses and treatment history approximately 20 years after fertility treatment initiation

Background

Infertility history may have important implications for clinical practice and scientific discovery. Previous research on the validity of self-reported infertility measurements has been limited in scope and duration (< 5 years). In this study, we validated self-reported infertility history measures 15–23 years after fertility treatment initiation among women who utilized assisted reproductive technology (ART).

Methods

Women who received ART treatments from three Boston infertility clinics and who enrolled in a prior study (1994–2003) were re-contacted in 2018 for the AfteR Treatment Follow-up Study (ART-FS). Infertility history was collected from clinical records and two self-report questionnaires (at ART initiation and at ART-FS enrollment). Treatment history included specific details (fresh or frozen embryo transfers, number of cycles) and treatment recall prior to ART initiation. Self-reported infertility diagnoses included polycystic ovary syndrome (PCOS), endometriosis, uterine factor infertility, tubal factor infertility, diminished ovarian reserve/advanced maternal age, male factor infertility, and other/unknown. We compared self-reported measures from 2018 to self-reported and clinical data from prior study initiation, using Cohen’s kappa, sensitivity, specificity, and 95% confidence intervals.

Results

Of 2644 women we attempted to recontact, 808 completed the ART-FS, with an average follow-up of 19.6 years (standard deviation: 2.7). Recall of fertility treatment usage had moderate sensitivity (IVF = 0.85, Clomiphene/Gonadotropin = 0.81) but low specificity across different infertility treatment modalities (IVF = 0.63, Clomiphene/Gonadotropin = 0.55). Specific IVF details had low to moderate validity and reliability with clinical records. Reliability of recalled infertility diagnosis was higher when compared to self-report at ART initiation (PCOS K = 0.66, Endometriosis K = 0.76, Tubal K = 0.73) than when compared to clinical records (PCOS K = 0.31, Endometriosis K = 0.48, Tubal K = 0.62) and varied by diagnosis.

Conclusions

The ability of women to recall specific IVF treatment details was moderately accurate and recall of self-reported infertility diagnosis varied by diagnosis and measurement method.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40738-021-00099-2.

Utilization of telehealth in paediatric genome-wide sequencing: Health services implementation issues in the CAUSES Study

INTRODUCTION

Genome-wide sequencing (exome or whole genome) is transforming the care and management of paediatric patients with a rare disease because of its diagnostic capabilities. Genome-wide sequencing is most effective when both parents and the child are sequenced as a trio. Genetic counselling is recommended for all families considering genome-wide sequencing. Although telehealth is well established in genetic counselling for hereditary cancer and prenatal genetics, its use with genome-wide sequencing has not been well studied. The CAUSES Clinic at BC Children's and Women's Hospitals was a translational paediatric trio-based genome-wide sequencing initiative. Pre-test genetic counselling via telehealth (at a clinical site near the family's residence) was offered to families who had been previously evaluated by a clinical geneticist. We report on the first 300 families seen in the CAUSES clinic and compare health services implementation issues of families seen via telehealth versus on-site.

METHODS

Demographics, cost to families (travel and time), time to first appointment, complete trio sample accrual and diagnostic rates were studied.

RESULTS

Of the 300 patients, 58 (19%) were seen via telehealth and 242 (81%) were seen on-site for pre-test counselling. The mean time to completion of accrual of trio samples in the telehealth group was 56.3 (standard deviation ±87.3) days versus 18.9 (standard deviation ±62.4) days in the onsite group (p < 2.2 × 10^-16). The mean per-family estimated actual or potential travel/time cost savings were greater in the telehealth group (Can$987; standard deviation = Can$1151) than for those seen on-site (Can$305; standard deviation = Can$589) (p = 0.0004).

CONCLUSIONS

Telehealth allowed for access to genome-wide sequencing for families in remote communities and for them to avoid significant travel and time costs; however, there was a significant delay to accrual of the complete trio samples in the telehealth group, impacting on time of result reporting and delaying diagnoses for families for whom genome-wide sequencing was diagnostic.

Recall accuracy of weekly automated surveys of health care utilization and infectious disease symptoms among infants over the first year of life

Automated surveys, by interactive voice response (IVR) or email, are increasingly used for clinical research. Although convenient and inexpensive, they have uncertain validity. We sought to assess the accuracy of longitudinally-collected automated survey responses compared to medical records. Using data collected from a well-characterized, prospective birth cohort over the first year of life, we examined concordance between guardians' reports of their infants' health care visits ascertained by weekly automated survey (IVR or email) and those identified by medical chart review. Among 180 survey-visit pairs, concordance was 51%, with no change as number of visits per baby increased. Accuracy of recall was higher by email compared to IVR (61 vs. 43%; adjusted OR = 2.5 95% CI: 1.3-4.8), did not vary by health care encounter type (hospitalization: 50%, ER: 64%, urgent care: 44%, primary care: 52%; p = 0.75), but was higher for fever (77%, adjusted OR = 5.1 95%CI: 1.5-17.7) and respiratory illness (58%, adjusted OR = 2.9 95%CI: 1.5-5.8) than for other diagnoses. For the 75 mothers in these encounters, 69% recalled at least one visit; among 41 mothers with two or more visits, 85% recalled at least one visit. Predictors of accurate reporting by mothers after adjusting for illness in the baby included increased age and increased years of education (age per year, β = 0.05, p = 0.03; education per year, β = 0.08, p = 0.04). Additional strategies beyond use of automated surveys are needed to ascertain accurate health care utilization in longitudinal cohort studies, particularly in healthy populations with little motivation for accurate reporting.

Allocating healthcare resources to genomic testing in Canada: latest evidence and current challenges

Precision medicine (PM) informed by next-generation sequencing (NGS) poses challenges for health technology assessment (HTA). To date, there has been limited reimbursement of genomic testing with NGS in Canada, particularly for whole-genome and whole-exome sequencing (WGS/WES). Through a structured literature review, we examine Canadian economic evidence and evidentiary challenges for the adoption of genomic testing. We searched Medline (PubMed) for published Canadian studies generating economic evidence for PM informed by NGS. Our search focused on studies examining the costs and/or value of NGS. We reviewed included studies and summarized results according to evaluation type, clinical context, NGS technology, and test strategy. We then grouped HTA challenges encountered by authors when evaluating NGS. Our review included twenty-five studies. To determine the economic impacts of NGS-informed PM in Canada, studies applied cost-effectiveness analysis (52%, n = 13), stated preference analysis (20%, n = 5), cost-consequence analysis (16%, n = 4), and healthcare resource utilization or costing analysis (12%, n = 3). NGS panels were the most common technology evaluated (n = 13), followed by WGS and/or WES (n = 8). The included studies highlighted multiple challenges when generating economic evidence, many of which remain unaddressed. Challenges were broadly related to (1) accounting for all NGS outcomes; (2) addressing uncertainty; and (3) improving consistency of economic approaches. Canadian studies are beginning to produce estimates of the economic impacts of NGS-informed PM, yet challenges for HTA remain. While solutions and real-world evidence are generated, lifecycle health technology management methods can be designed to better support resource allocation decisions for genomic testing in Canada.