A comparative cost analysis of newborn screening for classic congenital adrenal hyperplasia in Texas.
OBJECTIVE
Texas mandates a two-test newborn screening program for congenital adrenal hyperplasia (CAH): one test at birth and a second test at approximately one to two weeks after birth. The authors compared the dollar cost of detecting infants with CAH clinically and through the screening program.


METHODS
The authors estimated the costs of screening newborns in 1994 for CAH, including resources used by the Texas Department of Health and the broader cost to society.


RESULTS
Fifteen infants with classic CAH were diagnosed in Texas in 1994 among 325,521 infants born (1:21,701 cumulative incidence). Seven infants were detected clinically and the others were detected through screening, six on the first screen and two on the second screen. The first screen identified all previously undetected infants with severe salt-wasting CAH. The cumulative cost to diagnose the seven infants detected clinically was $79,187. The incremental costs for the screening program were $115,169 per additional infant diagnosed through the first screen and $242,865 per additional infant diagnosed through the second screen.


CONCLUSIONS
If the goal is early diagnosis of infants with the severe salt-wasting form of CAH, a single screen is effective. If the goal is to detect infants with the simple virilizing form of the disorder who may benefit from early treatment, the second screen is necessary, but it is not as cost-effective as the first screen.
Brosnan
C A
CA
School of Nursing, Univ. of Texas--Houston 77030, USA. cbrosnan@son1.nur.uth.tmc.edu
Brosnan
P
P
Therrell
B L
BL
Slater
C H
CH
Swint
J M
JM
Annegers
J F
JF
Riley
W J
WJ
D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis / Q000517:prevention & control*; D000367:Age Factors; D001724:Birth Weight; D003365:Costs and Cost Analysis; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000191:economics* / Q000379:methods; D013781:Texas