Universal or targeted screening for fetal alcohol exposure: a cost-effectiveness analysis.
OBJECTIVE
In this article, we compared the costs of testing meconium for alcohol exposure in newborns with the lifetime benefits of early detection and intervention.


METHODS
A decision analytic model was developed to assess the cost-effectiveness of testing meconium for two scenarios: (1) all infants in the Canadian province of Ontario and (2) infants who have an older sibling diagnosed with fetal alcohol spectrum disorder (FASD). The model incorporated the costs of early screening, early intervention, and the lifetime societal benefits of early intervention.


RESULTS
The cost of the meconium test is Can. $150. The lifetime societal cost of the disease is Can. $1.3 million per incident case. The benefit of early intervention is an improvement in literacy, which improves the quality of life parameter by 0.17 and increases adult lifetime earnings by $26,400 per year. The ratio of the incremental cost to the incremental benefits results in an incremental cost-effectiveness ratio for mandating a universal screen of all newborns in Ontario of $65,874 per quality-adjusted life years. When considering targeted screening, there is a cost savings for society and improvements in quality of life.


CONCLUSIONS
Depending on society's willingness-to-pay threshold for improving infants' lives in a setting of considerable equity concerns, universal screening and targeted screening of infants who have an older sibling diagnosed with FASD both represent policies that are good value for the money.
Hopkins
Robert B
RB
Program for Assessment of Technology in Health, Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, 25 Main Street West, Suite 2000, Hamilton, Ontario, L8P 2A1, Canada. hopkinr@mcmaster.ca
Paradis
Jon
J
Roshankar
Tozheg
T
Bowen
James
J
Tarride
Jean-Eric
JE
Blackhouse
Gord
G
Lim
Morgan
M
O'Reilly
Daria
D
Goeree
Ron
R
Longo
Christopher J
CJ
D015415:Biomarkers / Q000032:analysis; D003362:Cost-Benefit Analysis; D018479:Early Intervention, Educational / Q000191:economics; D005227:Fatty Acids / Q000032:analysis; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis / Q000191:economics* / Q000534:rehabilitation; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008470:Meconium / Q000737:chemistry; D018803:Models, Economic; D015997:Neonatal Screening / Q000191:economics*; D009864:Ontario; D011237:Predictive Value of Tests; D011247:Pregnancy; D019057:Quality-Adjusted Life Years; D012307:Risk Factors
D015415:Biomarkers; D005227:Fatty Acids