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Following is a question by the Hon Chiang Lai-wan and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (April 24):
Question:
At present, public hospitals will screen the foetuses of all pregnant women undergoing prenatal check-ups for Down's syndrome by means of ultrasound examinations and blood tests, etc., and will perform a further test in the form of amniocentesis for pregnant women of suspected cases. As amniocentesis is an invasive diagnostic test, it is associated with a 0.5% to 1% risk of miscarriage. On the other hand, a local university has successfully developed the T21 test, a non-invasive prenatal diagnostic technique, which can safely and accurately screen a foetus for Down's syndrome by conducting tests on chromosome 21 in the pregnant woman's blood plasma. It has been learnt that T21 tests have been used in quite a number of countries in the world, but they have not yet been commonly used in Hong Kong, and the tests are also more expensive than the traditional tests. In this connection, will the Government inform this Council:
(a) whether it knows the respective numbers and percentages of pregnant women who underwent amniocentesis and T21 tests in each of the past three years; among them, whether there were any miscarriages due to amniocentesis; if so, of the number of such cases; of the average age and household income of those pregnant women who underwent T21 tests in the past three years, and whether all those T21 tests performed were self-financed;
(b) whether it knows the total expenditure of the Hospital Authority (HA) for performing amniocentesis and the number of pregnant women who underwent such a test in each of the past three years; whether there were cases in which the expenses for T21 tests were borne by HA; if so, of the reasons for that; of the estimated amount of public money to be spent each year should the costs for T21 tests be fully covered by public hospitals, and how such an amount compares with the public money spent annually on direct and indirect subsidies for people with Down's syndrome;
(c) of the number of newborn babies with Down's syndrome and the percentage of such number in the total number of live births in each of the past three years; and the total number of people with Down's syndrome in Hong Kong at present; and
(d) whether the Government will consider a comprehensive introduction of T21 tests for public healthcare service in the next financial year; if it will, of the details; if not, the reasons for that?
Reply:
President,
The Government attaches great importance to providing appropriate and comprehensive prenatal service to pregnant women. The Maternal and Child Health Centres (MCHCs) under the Department of Health (DH), in collaboration with the Obstetrics Departments of the Hospital Authority (HA), provide a comprehensive prenatal shared-care programme to pregnant women to monitor the whole pregnancy and delivery process. The first prenatal checkup includes checking of personal and family medical history, physical and gynaecological examination, urinalysis for glycosuria and proteinuria, blood test, etc. Depending on the conditions and wishes of the pregnant women, specific tests will be arranged by healthcare staff where necessary, which include ultrasound scan, blood sugar and oral glycemea tolerance test, amniocentesis, chorionic villus sampling, umbilical cord blood sampling, etc.
My consolidated reply to the four parts of the question is as follows:
Public hospitals have been providing a series of prenatal screening for Down's syndrome, including basic blood test and ultrasound examination, for all local pregnant women since mid-2011. For suspected cases (around 6% or 2 000-odd cases per year), amniocentesis or chorionic villous sampling will be offered to identify Down's syndrome in foetuses.
HA does not keep statistics on the number of miscarriage cases due to amniocentesis or chorionic villous sampling, nor does it have a breakdown of the expenditure incurred.
As "T21 test" is not a service currently available from HA and DH, we do not have information on the pregnant women who have undergone the test and the expenditure incurred. We also do not have any statistics on the number of newborn babies with Down's syndrome and the total number of people with Down's syndrome in Hong Kong, nor do we have statistics on the healthcare expenditure for patients with Down's syndrome.
It should be noted that even if a foetus is diagnosed with Down's syndrome by whatever methods, whether the pregnant woman concerned will consequently terminate pregnancy or continue with pregnancy and delivery depends on her clinical condition and personal choice. The types of tests used to screen the foetuses do not help prevent babies from having Down's syndrome, neither could the medical services provided to persons with Down's syndrome be withdrawn accordingly.
DH and HA will study and make recommendations on the latest development of medical technology on Down's syndrome. A committee under HA is in place to examine various new medical technologies. HA will, look into the effectiveness of relevant developments for continual improvement in clinical services in accordance with the established mechanism.
Ends/Wednesday, April 24, 2013
Issued at HKT 14:11
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