Newborn screening with tandem mass spectrometry: examining its cost-effectiveness in the Wisconsin Newborn Screening Panel.
OBJECTIVE
To examine the cost-effectiveness of tandem mass spectrometry (MS/MS) in a neonatal screening panel for 14 fatty acid oxidation and organic acidemia disorders in the Wisconsin Newborn Screening Program.


METHODS
An incremental cost-effectiveness analysis with a hypothetical cohort of 100,000 infants was performed. A threshold of $50,000/QALY (quality-adjusted life-year) was used to determine whether screening for medium-chain acyl-CoA dehydrogenase deficiency (MCAD) alone is cost-effective or whether additional disorders would need to be incorporated into the analysis to arrive at a conclusion regarding the overall cost-effectiveness of MS/MS.


RESULTS
Under conservative assumptions, screening for MCAD alone yields an incremental cost-effectiveness ratio of $41,862/QALY. With the use of more realistic assumptions, screening becomes more cost-effective ($6008/QALY) and remains cost-effective so long as the incremental cost of screening remains under $13.05 per test. Adding the incremental costs of detecting the 13 other disorders on the screening panel still yields a result well within accepted norms for cost-effectiveness ($15,252/QALY).


CONCLUSIONS
In Wisconsin, MS/MS screening for MCAD alone appears to be cost-effective. Future analyses should examine the cost-effectiveness of alternative follow-up and treatment regimens for MCAD and other panel disorders.
Insinga
Ralph P
RP
Department of Population Health Sciences and the Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, 53726-2397, USA.
Laessig
Ronald H
RH
Hoffman
Gary L
GL
D042964:Acyl-CoA Dehydrogenase; D044944:Acyl-CoA Dehydrogenases / Q000172:deficiency / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000191:economics; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007229:Infant Welfare; D007231:Infant, Newborn; D013058:Mass Spectrometry / Q000191:economics; D008661:Metabolism, Inborn Errors / Q000175:diagnosis / Q000191:economics / Q000401:mortality; D015997:Neonatal Screening / Q000191:economics; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014922:Wisconsin / Q000453:epidemiology
D044944:Acyl-CoA Dehydrogenases; D042964:Acyl-CoA Dehydrogenase