[Evaluation of the cost-effectiveness of school screening for hereditary hemoglobin abnormalities: prospective study in Bouches-du-Rhône. School screening for hemoglobinopathies].
Screening in schools for heterozygote carriers of haemoglobinopathies traits has been carried out experimentally in southeast France ("Bouches du Rhône", the Marseille region) since 1977. The study compares, in cost-effectiveness terms, the screening strategy now followed with 27 alternative strategies in all the pupils (14-16 years). Although the frequency of heterozygote carriers in this school population as a whole is only 7.9% carriers for beta-thalassaemia gene and 2.5% carriers for HbS, prospective costs per diagnosis still seem reasonable: from 1544 to 4997 French francs (1987) depending on the strategy, and 2099 to 7380 francs if beta-thalassaemia alone is screened. In comparison with the current screening strategy, cost-effectiveness ratios could be improved by using haemoglobin electrophoresis as a preselection test, or a blood count if beta-thalassaemia alone is screened. Further improvement of cost-effectiveness ratios could be obtained by limiting screening to ethnic groups most "at risk"; but such strategies raise ethical and acceptability issues.
Moatti
J P
JP
INSERM Unité 240, Fontenay-aux-Roses.
Le Gales
C
C
Lena
D
D
Orsini
A
A
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000235:genetics; D003362:Cost-Benefit Analysis; D005260:Female; D005602:France; D006580:Genetic Carrier Screening; D005820:Genetic Testing; D006451:Hemoglobin, Sickle / Q000235:genetics; D006453:Hemoglobinopathies / Q000175:diagnosis* / Q000235:genetics; D006801:Humans; D008297:Male; D012572:School Health Services / Q000191:economics*; D013789:Thalassemia / Q000235:genetics
D006451:Hemoglobin, Sickle
Evaluation coût-efficacité du dépistage scolaire des anomalies héréditaires de l'hémoglobine: une étude prospective dans les Bouches-du-Rhône. Dépistage scolaire des hémoglobinoses.