Health economic analysis of the Swedish neonatal metabolic screening programme. A method of optimizing routines.
A benefit-cost analysis was carried out to optimize the routines for neonatal metabolic screening. The basis of the study was provided by results of the Swedish neonatal screening programme from 1965 to 1979. During this period over one million infants were screened by the Guthrie test for phenylketonuria and galactosaemia, and for limited periods also for tyrosinaemia, homocystinuria and histidinaemia. The benefit-cost ratio was calculated for combinations of different screening tests, recall routines, and varying degrees of coverage. The largest benefit-cost ratio was obtained with combined screening for phenylketonuria and galactosaemia, using a borderline blood phenylalanine level of 0.50 mmol/L in the Guthrie test for phenylketonuria. However, the inaccuracy of this test necessitated the use of a lower blood phenylalanine level of 0.25 mmol/L and the acceptance of a lower benefit-cost ratio. An increase in the present 98% coverage of newborns by the screening programme was found to be an effective means of improving the benefit-cost ratio in the present programme.
D000592:Amino Acid Metabolism, Inborn Errors / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D005693:Galactosemias / Q000517:prevention & control; D006639:Histidine / Q000097:blood; D006712:Homocystinuria / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening / Q000191:economics*; D008661:Metabolism, Inborn Errors / Q000517:prevention & control*; D010661:Phenylketonurias / Q000517:prevention & control; D013548:Sweden; D014443:Tyrosine / Q000097:blood
D014443:Tyrosine; D006639:Histidine