A cost-effectiveness evaluation of newborn hemoglobinopathy screening from the perspective of state health care systems.
OBJECTIVE
To determine the most cost-effective strategy for newborn hemoglobinopathy screening from the perspective of state health care systems.


METHODS
Using Alaska as an example, we used decision analysis to compare a policy of no screening to universal or targeted screening with selective follow-up only of infants who are homozygous or compound heterozygous for an abnormal hemoglobin variant and to universal or targeted screening with complete follow-up, including follow-up of infants with clinically insignificant traits. Probabilities and costs were varied over values that might be expected for other states.


RESULTS
Among the selective follow-up options, targeted screening would be the most cost-effective strategy for Alaska at a cost of $206,192 per death averted; by contrast, universal screening would prevent 50% more deaths at an incremental cost of $2,040,000 per death averted. Universal would be more cost-effective than targeted screening for several scenarios expected to occur in other states, including a high sickle cell disease prevalence, a low screening test cost, and a high cost per screen associated with racial targeting. Among the complete follow-up options, both targeted and universal screening would cost at least $200,000 per death averted over the range of all variables tested during sensitivity analysis; the incremental cost of universal versus targeted screening would be at least $600,000 per death averted.


CONCLUSIONS
Our data suggest each state should determine the most cost-effective option based on state-specific values for sickle cell disease prevalence, test costs and racial targeting costs.
Gessner
B D
BD
Alaska Division of Public Health, Section of Epidemiology, Anchorage 99501, USA.
Teutsch
S M
SM
Shaffer
P A
PA
D000413:Alaska; D000755:Anemia, Sickle Cell / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care; D006453:Hemoglobinopathies / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000191:economics*; D044469:Racial Groups; D012680:Sensitivity and Specificity; D013219:State Government