(647) Patient Cost Willingness for Diagnostic Prenatal Testing in a Region with Poor Insurance Coverage

Objective: Various tiers of diagnostic prenatal testing with karyotype, chromosomal microarray (CMA), next-generation sequencing (NGS) panels and whole exome/genome sequencing (WES/WGS) are available; however, insurance coverage for these tests is variable. We evaluated the costs that pregnant individuals were willing to pay for these various tests and compared costs by insurance and genetic-risk status.

Study Design: We performed a prospective study of individuals seeking prenatal care at a large urban US academic center (3/2020-8/2022). Consenting persons were administered an electronic survey introducing the test types (i.e. karyotype, CMA, NGS, WES) and then assessing their attitudes regarding various levels of genetic information and willingness to obtain these tests, including costs. The primary outcome was cost range participants were willing to pay for karyotype, CMA, NGS panel, or WES/WGS (Figure). Frequencies of cost ranges for each test were computed for the study population, and compared between insurance types (private vs public) and genetic risk levels (low vs high-risk [i.e. abnormal genetic screening, fetal anomalies]).

Results: Of 1596 individuals approached for this study, 895 enrolled - 776 low-risk (54% public insurance) and 119 high-risk (55% public insurance). Our cohort was on average 27 ± 6yrs, primarily Black (55%) with ≥ high school education (92%). Most respondents            ( >50%) reported willingness to get any of the tests only if covered by insurance (Figure). This was similar for low and high-risk groups (p >0.05 for all test types). Publicly and privately insured patients had different cost willingness (all p< 0.001). While the majority of both groups were willing to get testing only if covered by insurance, >25% of publicly insured participants reported they would never get testing, regardless of cost. Others with public insurance were twice as likely to be willing to pay any cost vs. those with private insurance (Figure).

Conclusion: Financial willingness to obtain various diagnostic prenatal tests is based on insurance coverage, thus, efforts to universally improve coverage are needed.