Costing model for neonatal screening and diagnosis of haemoglobinopathies
a Department of Public Health Policy London
School of Hygiene and Tropical Medicine London, b Department of Haematology
Central Middlesex Hospital London, c Directorate of Public Health & Health Policy
Brent and Harrow Health Authority Middlesex, d Imperial College School of Medicine
Central Middlesex Hospital
Correspondence to: Professor Sally Davies, Research and Development, NHS Executive North Thames, Department of Health, 40 Eastbourne Terrace, London W2 3QR.
Accepted 12
June 1998
AIM
To compare the costs and cost effectiveness of
universal and targeted screening for the haemoglobinopathies; to
compare the cost of two laboratory methods; and to estimate the cost
effectiveness of programmes at different levels of prevalence and mix
of haemoglobinopathy traits.
METHODSA retrospective review of laboratory and
follow up records to establish workload and costs, and estimation of
costs in a range of circumstances was made in a haematology department
and sickle cell and thalassaemia centre, providing antenatal and
neonatal screening programmes in Inner London. The costs for 47 948 babies, screened during 1994, of whom 25 had clinically significant
haemoglobinopathies and 704 had haemoglobinopathy traits, were
retrospectively assessed.
RESULTSThe average cost per baby tested
(isoelectric focusing and high power liquid chromatography) was
£3.51/£3.83 respectively; the cost per case of sickle cell disease
identified (IEF/HPLC) was £6738/ £7355; the cost per trait identified
(IEF/HPLC) was £234/£255; the cost per extra case of SCD and trait
identified by universal programme varied.
CONCLUSIONSIEF and HPLC are very similar in terms
of average cost per test. At 16 traits/1000 and 0.5 SCD/1000 there was
no significant identification cost difference between universal and
targeted programmes. Below this prevalence, a targeted programme is
cheaper but likely to miss cases of SCD. If targeted programmes were
90-99% effective, universal programmes would cease to be good value
except at very high prevalence. Greater use of prenatal diagnosis,
resulting in termination, and therefore fewer affected births, reduces
the cost effectiveness of universal screening. Screening services should aim to cover a screened population which will generate a
workload over 25 000 births a year, and preferably over 40 000.
© 1998 by Archives of Disease in Childhood
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