should the norwegian public prenatal care program include an ultrasound scan in the first trimester?
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Should the Norwegian public prenatal care program include an ultrasound scan in the first trimester?TRANSCRIPT
Siv Cathrine Høymork, Hege Wang, Vigdis Lauvrak, Ånen RingardSecretariat for the National Council for Priority setting in Health Care
The Norwegian Knowledge Centre for the Health Services
Should the Norwegian public prenatal care program include an ultrasound scan in the first trimester?
Health care in Norway
Mainly publicly provided and financed
The public prenatal care program is free of any costs for the pregnant women
National Council for Priority setting in Health Care Established in 2007 by the Ministry of Health An advisory board for assessing new technologies 26 members
Executives from the central health administration and regional health authorities
Executives from municipalities and their organisation Leaders from patient associations Representatives from universities and colleges
Chaired by the Director-General of the Norwegian Directorate of Health; deputy chairperson is the Director-General of the Norwegian Institute of Public Health
Secretariat at the Norwegian Knowledge Centre (the national HTA-institution)
Framework for priority setting
The Priority Setting Regulation is founded on the Patient’s Rights Act
Three criteria should be fulfilled: Severity
”the patient will experience a certain reduction in prognosis with regard to life expectancy or a considerable reduction in quality of life if the provision of a health intervention is deferred”
Effectiveness”the patient may expect to benefit from the health intervention”
Cost-effectiveness”the expected costs are in a reasonable proportion to the effects”
Should a publicly financed early (weeks 11-13) ultrasound scan be offered to pregnant women?
2008
2011
Case processing in the National council, spring 2011
14.2.: case put forward
11.4.: case initially discussed in the council
Not sufficient documentation to suggest that ultrasound provides health benefit to the mother and/or foetus
Case was to be further investigated, including an assessment of effects with respect to different medical conditions as well as health economic effects
Assessment was to be jointly conducted by the Directorate of Health, the Knowledge Centre and relevant professional groups. The case would subsequently be re-examined by the council.
An HTA working-group was established
Specialists in foetal medicine Gynaecologist Paediatrician Midwife Specialists in medical ethics Norwegian Birth Registry Systematic reviewers Librarians Health economists
Case handled in the National council on December 5th
Summary of the findings in the HTA-report from was presented:
No documented health benefit More women satisfied with
prenatal care Fewer children with Down
syndrome will be born Rise in costs not evident
The Norwegian Council for Quality Improvement and Priority
Setting in Health Care considers it essential that the publicly
provided prenatal care program should be assured, safe, and
maintain a high professional standard.
Routine ultrasound scans should be offered in weeks 11-13
and 17-19 in order to
- ensure that the objectives of ultrasound scanning in
pregnancy are attended to at the earliest possible
opportunity
- ensure that the examination meets professional
standards
Prior to implementation, the consequences regarding
economics and priority setting should be evaluated by means
of pilot testing.
Final resolution
Final resolution - justification
Pregnant women more satisfied - major objective within prenatal care programme
Better to be informed sooner rather than later if something is wrong
Ensure high standards to avoid unnecessary waste of resources on follow-up
Counteract the geographic and economic barriers to access Expenses not likely to rise Publicly provided programme in place in many other countries
Conclusion
Despite the fact that the HTA revealed no health gain for the mother or the foetus, the Council recommended that an additional ultrasound scan should be offered in the prenatal care programme.
The advice challenge the official criteria stated in the Priority Setting Regulation.
The final decision will be made by the Parliament.