Potential costs and benefits of newborn screening for severe combined immunodeficiency.
OBJECTIVE
Severe combined immunodeficiency (SCID) is a rare, treatable disorder of the immune system. The incidence is unknown but may be more common than published estimates because infants frequently die of infection before diagnosis. SCID is a candidate for universal newborn screening, so there is a need to determine under which circumstances screening would be cost-effective.


METHODS
We assumed a screening program for SCID would use T-cell lymphopenia as the screening criterion and performed a cost-utility analysis comparing universal screening with screening only those with a family history of SCID.


RESULTS
Assuming society is willing to pay $50,000 for every quality-adjusted life-year saved, a SCID screening test that cost less than $5 with a false-negative rate of 0.9% and a false-positive rate of 0.4% would be considered cost-effective. A nationwide screening program would cost an additional $23.9 million per year for screening costs but would result in 760 years of life saved per year of screening. The cost to detect 1 case of SCID would be $485,000.


CONCLUSIONS
SCID screening could result in a large benefit to detected individuals, making screening relatively cost-effective in spite of the low incidence of the disease. However, an adequate test is critical to cost-effectiveness.
McGhee
Sean A
SA
Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095-1752, USA. smcghee@mednet.ucla.edu
Stiehm
E Richard
ER
McCabe
Edward R B
ER
D016026:Bone Marrow Transplantation / Q000191:economics; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D017048:Health Care Costs; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics; D007231:Infant, Newborn; D017059:Models, Econometric; D015997:Neonatal Screening / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D016511:Severe Combined Immunodeficiency / Q000517:prevention & control*; D014481:United States
D016756:Immunoglobulins, Intravenous