Test of sperm DNA integrity and the development of mental illness in the offspring, a preliminary cost-effectiveness analysis
Authors
Udesen, Adrian Michalak ; Poulsen, Nicklas Smed
Term
4. term
Publication year
2020
Submitted on
2020-05-31
Pages
27
Abstract
Background: Conventional semen assessment focuses on count, morphology, and motility, but emerging evidence suggests sperm DNA integrity (measured as DFI via SCSA flow cytometry) reflects sperm quality and possibly paternal health. Higher paternal age is linked to more de novo mutations and increased risk of mental disorders in offspring, and lifestyle changes may improve sperm DNA integrity. Objective: To conduct a preliminary health economic analysis of whether preconception testing of sperm DNA integrity could be cost-effective by reducing the risk of schizophrenia or bipolar disorder in offspring. Methods: A decision-analytic model (TreeAge Pro 2019) estimated cost-effectiveness assuming a hypothetical absolute 1% reduction in offspring risk of schizophrenia or bipolar disorder if testing is implemented. Incremental cost-effectiveness ratios were calculated for both conditions, with probabilistic sensitivity analysis and a tornado diagram; discounted cost scenarios were also explored. Results: Without discounting, the testing strategy was dominant (lower costs and better outcomes) for both schizophrenia and bipolar disorder; uncertainty was examined through sensitivity analyses. Conclusion: Under the assumed 1% risk reduction, this preliminary evaluation indicates a potential health economic benefit of implementing sperm DNA integrity testing, but direct evidence linking elevated DFI to offspring mental illness is scarce. Further empirical research on clinical effectiveness, quality of life, adherence, and long-term effects is needed.
Baggrund: Traditionelle sædanalyser vurderer antal, morfologi og motilitet, men nyere forskning peger på, at DNA-integritet i sædceller (målt som DFI med SCSA-flowcytometri) kan afspejle sædkvalitet og muligvis fars generelle helbred. Højere faderalder er forbundet med flere de novo-mutationer og øget risiko for psykiske sygdomme hos afkom, og livsstilsændringer kan potentielt forbedre sæd-DNA-integritet. Formål: At gennemføre en foreløbig sundhedsøkonomisk analyse af om test af sæd-DNA-integritet før undfangelse kan være omkostningseffektiv ved at reducere risikoen for skizofreni eller bipolar lidelse hos afkommet. Metoder: Et beslutningsanalytisk modelstudie (TreeAge Pro 2019) estimerede omkostningseffektivitet under antagelsen om en hypotetisk absolut risikoreduktion på 1% i udviklingen af skizofreni eller bipolar lidelse, hvis testning iværksættes. Der blev beregnet ICER for begge sygdomme og gennemført probabilistisk sensitivitetsanalyse samt tornadodiagram; effekten af diskontering blev også undersøgt. Resultater: Uden diskontering var teststrategien dominerende (lavere omkostninger og bedre udfald) for både skizofreni og bipolar lidelse; usikkerhed blev udforsket i følsomhedsanalyser. Konklusion: Under den antagne 1% risikoreduktion tyder denne foreløbige evaluering på en potentiel sundhedsøkonomisk gevinst ved at implementere sæd-DNA-integritetstest, men evidensen for en direkte sammenhæng mellem høj DFI og psykisk sygdom hos afkom er sparsom. Yderligere empiriske studier af klinisk effekt, livskvalitet, efterlevelse og langsigtede effekter er nødvendige.
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