Reducing Periconceptional Methylmercury Exposure: Cost–Utility Analysis for a Proposed Screening Program for Women Planning a Pregnancy in Ontario, Canada

http://dx.doi.org/10.1289/ehp.1409034



Table 1. Data elements of the economic model.
Data element Base analysis Source
Abbreviations: EQ5D, EuroQuol-5D, European quality of life–5 dimensions; MMR, mild mental retardation (IQ between 50 and 70); QALY, quality-adjusted life year; SEPPA, special education per pupil amount. Disutility is defined as the loss in utility.
aThe proportion of live births for a given age range out of the total live births over all maternal ages. bThe proportion of co-habiting couples who did not become pregnant after exposure to the risk of conception during the previous 12 months.
Blood Hg distribution StatCan 2013
Women 20–39 years of age
Geometric mean 0.66 μg/L (95% CI: 0.47, 0.92)
75th percentile 1.6 μg/L (95% CI: 1.1, 2.1)
Women 40–59 years of age
Geometric mean 0.82 μg/L (95% CI: 0.65, 1.0)
75th percentile 1.7 μg/L (95% CI: 1.1 2.2)
90th percentile 2.9 μg/L (95% CI: 1.9, 3.9)
Ratio cord to maternal blood Hg 1.7 Stern and Smith 2003
Weighted average of standard deviation of mercury effect
on neurobehavioral test from true prenatal exposure doubling
9.36% Budtz-Jørgensen et al. 2007
Intervention Kim et al. 2006
Probability of successful intervention 0.857
Effectiveness of successful intervention 0.556
Effectiveness of unsuccessful intervention 0
Live birth rate by maternal age (years)a StatCan 2011
20–24 0.122
25–29 0.280
30–34 0.345
35–39 0.181
40–44 0.039
45–49 0.003
Infertility rate by maternal age (years)b Bushnik et al. 2012
18–24 0.070
25–29 0.085
30–34 0.108
35–39 0.130
40–44 0.143
Screening costs
Laboratory blood Hg test Can$23.27 MOHLTC 2012
Family doctor, intermediate appointment Can$33.70 MOHLTC 2013
Remedial education SEPPA costs OME 2012
JK–grade 4 Can$931.29
Grades 5–8 Can$715.34
Grades 9–12 Can$472.92
QALY disutility for MMR (EQ5D) –0.38 Oostenbrink et al. 2002
Discount rate 5% CADTH 2006