Costing model for neonatal screening and diagnosis of haemoglobinopathies
- aDepartment of Public Health Policy London School of Hygiene and Tropical Medicine London, bDepartment of Haematology Central Middlesex Hospital London, cDirectorate of Public Health & Health Policy Brent and Harrow Health Authority Middlesex, dImperial College School of Medicine Central Middlesex Hospital
- Professor Sally Davies, Research and Development, NHS Executive North Thames, Department of Health, 40 Eastbourne Terrace, London W2 3QR.
- Accepted 12 June 1998
Abstract
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.
METHODS A 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.
RESULTS The 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.
CONCLUSIONS IEF 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.
