Is universal neonatal hemoglobinopathy screening cost-effective?
OBJECTIVE
To determine whether and where universal neonatal screening for hemoglobinopathies, chiefly sickle-cell disease, could be performed at socially acceptable costs.


METHODS
We made projections of the cost-effectiveness of nonuniversal and universal sickle-cell disease screening throughout the United States. We then compared the cost-effectiveness of universal sickle-cell disease screening with that of universal phenylketonuria screening. Finally, we asked if "high-cost" states, that is, those in which the cost of finding a case of sickle-cell disease exceeded one half the cost of finding a case of phenylketonuria, could enhance their cost-effectiveness by joining demographically complementary states in screening cooperatives.


RESULTS
If all states conducted independent screening and if the value of finding a case of sickle-cell disease were no more than one half that of finding a case of phenylketonuria, seven of the 19 states that do not currently conduct universal screening for hemoglobinopathies would begin to do so, but six of the 34 that currently do so would stop. Of the six that would stop, three have already formed a screening cooperative, reducing their projected average costs for finding either sickle-cell disease or phenylketonuria or both; the other three could similarly improve cost-effectiveness through cooperative arrangements. Nineteen states realize economies of scale in six cooperative groups; more could do so.


CONCLUSIONS
Universal neonatal hemoglobinopathy screening can be made available at socially acceptable costs to the citizens of demographically various states.
Sprinkle
R H
RH
Division of Policy and Ethics, Duke University-University of North Carolina Comprehensive Sickle Cell Center, Durham, NC.
Hynes
D M
DM
Konrad
T R
TR
D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D003625:Data Collection; D005069:Evaluation Studies as Topic; D005544:Forecasting; D006297:Health Services Accessibility; D006453:Hemoglobinopathies / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000191:economics*; D010661:Phenylketonurias / Q000453:epidemiology / Q000517:prevention & control; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology