Mitochondrial donation--how many women could benefit?
Ontology highlight
ABSTRACT:
SUBMITTER: Gorman GS
PROVIDER: S-EPMC4481295 | biostudies-literature | 2015 Feb
REPOSITORIES: biostudies-literature
Publications
Mitochondrial donation--how many women could benefit?
Gorman Gráinne S GS Grady John P JP Turnbull Doug M DM
The New England journal of medicine 20150128 9
Mitochondrial disease is maternally inherited and refractory to treatment, but assisted reproduction methods can result in unaffected pregnancies. The authors provide estimates of the number of affected pregnancies per year in the United Kingdom and the United States. ...[more]
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Project description:Study questionDoes an informed group of citizens endorse the clinical use of mitochondrial donation in a country where this is not currently permitted?Summary answerAfter hearing balanced expert evidence and having opportunity for deliberation, a majority (11/14) of participants in a citizens' jury believed that children should be able to be born using mitochondrial donation.What is known alreadyResearch suggests that patients, oocyte donors and health professionals support mitochondrial donation to prevent transmission of mitochondrial disease. Less is known about public acceptability of this novel reproductive technology, especially from evidence using deliberative methods.Study design, size, durationThis study comprised a citizens' jury, an established method for determining the views of a well-informed group of community members. The jury had 14 participants, and ran over one and a half days in 2017.Participants/materials, setting, methodsJurors were members of the public with no experience of mitochondrial disease. They heard and engaged with relevant evidence and were asked to answer the question: 'Should Australia allow children to be born following mitochondrial donation?'Main results and the role of chanceEleven jurors decided that Australia should allow children to be born following mitochondrial donation; 7 of whom added conditions such as the need to limit who can access the intervention. Three jurors decided that children should not (or not yet) be born using this intervention. All jurors were particularly interested in the reliability of evidence, licensing/regulatory mechanisms and the rights of children to access information about their oocyte donors.Limitations, reasons for cautionJurors' views were well informed and reflected critical deliberation and discussion, but are not intended to be representative of the whole population.Wider implications of the findingsWhen presented with high quality evidence, combined with opportunities to undertake structured deliberation of novel reproductive technologies, members of the public are able to engage in detailed discussions. This is the first study to use an established deliberative method to gauge public views towards mitochondrial donation.Study funding/competing interest(s)This study was funded by a University of Sydney Industry and Community Collaboration Seed Award (2017), which was awarded contingent on additional funding from the Mito Foundation. Additional funding was provided by the Mito Foundation. The Foundation was not involved in jury facilitation or deliberation, nor analysis of research data.Trial registration numberNot applicable.
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Project description:BackgroundSince 2007, Medicare has provided one-time abdominal aortic aneurysm (AAA) screening for men with smoking history, and men and women with a family history of AAA as part of its Welcome to Medicare visit.ObjectiveWe examined utilization of the new AAA screening benefit and estimated how increased utilization could influence population health as measured by life years gained. Additionally, we explored the impact of expanding screening to women with smoking history.DesignAnalysis of Medicare claims and a simulation model to estimate the effects of screening, using published data for parameter estimates.SettingAAA screening in the primary care setting.PatientsNewly-enrolled Medicare beneficiaries aged 65 years, with smoking history or family history of AAA.Main measuresLife expectancy, 10-year survival rates.Key resultsMedicare data revealed low utilization of AAA screening, under 1% among those eligible. We estimate that screening could increase life expectancy per individual invited to screening for men with smoking history (0.11 years), with family history of AAA (0.17 years), and women with family history (0.08 years), and smoking history (0.09 years). Average gains of 131 life years per 1,000 persons screened for AAA compare favorably with the grade B United States Preventive Services Task Force (USPSTF) recommendation for breast cancer screening, which yields 95-128 life years per 1,000 women screened. These findings were robust over a range of scenarios.LimitationsThe simulation results reflect assumptions regarding AAA prevalence, treatment, and outcomes in specific populations based on published research and US survey data. Published data on women were limited.ConclusionsThe Welcome to Medicare and AAA screening benefits have been underutilized. Increasing utilization of AAA screening would yield substantial gains in life expectancy. Expanding screening to women with smoking history also has the potential for substantial health benefits.
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