title: Newborn screening by tandem mass spectrometry for glutaric aciduria type 1: a cost-effectiveness analysis.
abstract: BACKGROUND
  Glutaric aciduria type I (GA-I) is a rare metabolic disorder caused by inherited deficiency of glutaryl-CoA dehydrogenase. Despite high prognostic relevance of early diagnosis and start of metabolic treatment as well as an additional cost saving potential later in life, only a limited number of countries recommend newborn screening for GA-I. So far only limited data is available enabling health care decision makers to evaluate whether investing into GA-I screening represents value for money. The aim of our study was therefore to assess the cost-effectiveness of newborn screening for GA-I by tandem mass spectrometry (MS/MS) compared to a scenario where GA-I is not included in the MS/MS screening panel.
  
  
  METHODS
  We assessed the cost-effectiveness of newborn screening for GA-I against the alternative of not including GA-I in MS/MS screening. A Markov model was developed simulating the clinical course of screened and unscreened newborns within different time horizons of 20 and 70 years. Monte Carlo simulation based probabilistic sensitivity analysis was used to determine the probability of GA-I screening representing a cost-effective therapeutic strategy.
  
  
  RESULTS
  Within a 20 year time horizon, GA-I screening averts approximately 3.7 DALYs (95% CI 2.9 - 4.5) and about one life year is gained (95% CI 0.7 - 1.4) per 100,000 neonates screened initially . Moreover, the screening programme saves a total of around 30,682 Euro (95% CI 14,343 to 49,176 Euro) per 100,000 screened neonates over a 20 year time horizon.
  
  
  CONCLUSIONS
  Within the limitations of the present study, extending pre-existing MS/MS newborn screening programmes by GA-I represents a highly cost-effective diagnostic strategy when assessed under conditions comparable to the German health care system.
authors.forename: Johannes
authors.initials: J
authors.lastname: Pfeil
authors.forename: Stefan
authors.initials: S
authors.lastname: Listl
authors.forename: Georg F
authors.initials: GF
authors.lastname: Hoffmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Kölker
authors.forename: Martin
authors.initials: M
authors.lastname: Lindner
authors.affiliation: Department of General Paediatrics, Division of Inherited Metabolic Diseases, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, Heidelberg 69120, Germany. peter.burgard@med.uni-heidelberg.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Burgard
mesh_terms: D000592:Amino Acid Metabolism, Inborn Errors / Q000175:diagnosis*; D001928:Brain Diseases, Metabolic / Q000175:diagnosis*; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D050770:Glutaryl-CoA Dehydrogenase / Q000172:deficiency*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods*; D053719:Tandem Mass Spectrometry / Q000379:methods*
chemical_list: D050770:Glutaryl-CoA Dehydrogenase