title: Cost-benefit analysis: newborn screening for inborn errors of metabolism in Lebanon.
abstract: OBJECTIVE
  Few countries in the Middle East-North Africa region have adopted national newborn screening for inborn errors of metabolism by tandem mass spectrometry (MS/MS). We aimed to evaluate the cost-benefit of newborn screening for such disorders in Lebanon, as a model for other developing countries in the region.
  
  
  METHODS
  Average costs of expected care for inborn errors of metabolism cases as a group, between ages 0 and 18, early and late diagnosed, were calculated from 2007 to 2013. The monetary value of early detection using MS/MS was compared with that of clinical "late detection", including cost of diagnosis and hospitalizations.
  
  
  RESULTS
  During this period, 126000 newborns were screened. Incidence of detected cases was 1/1482, which can be explained by high consanguinity rates in Lebanon. A reduction by half of direct cost of care, reaching on average 31,631 USD per detected case was shown. This difference more than covers the expense of starting a newborn screening programme.
  
  
  CONCLUSIONS
  Although this model does not take into consideration the indirect benefits of the better quality of life of those screened early, it can be argued that direct and indirect costs saved through early detection of these disorders are important enough to justify universal publicly-funded screening, especially in developing countries with high consanguinity rates, as shown through this data from Lebanon.
authors.affiliation: Medical Genetic Unit, Saint-Joseph University, Beirut, Lebanon.
authors.forename: I
authors.initials: I
authors.lastname: Khneisser
authors.affiliation: Epidemiology and Population Studies Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: S
authors.initials: S
authors.lastname: Adib
authors.affiliation: Faculty of Sciences, Lebanese University, Beirut, Lebanon.
authors.forename: S
authors.initials: S
authors.lastname: Assaad
authors.affiliation: Medical Genetic Unit, Saint-Joseph University, Beirut, Lebanon.
authors.forename: A
authors.initials: A
authors.lastname: Megarbane
authors.affiliation: Department of Pediatrics and Adolescent Medicine, American University of Beirut- Medical Center, Beirut, Lebanon pk06@aub.edu.lb.
authors.forename: P
authors.initials: P
authors.lastname: Karam
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D008661:Metabolism, Inborn Errors / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D008962:Models, Theoretical; D015997:Neonatal Screening / Q000191:economics* / Q000379:methods; D053719:Tandem Mass Spectrometry
keywords: Arab; cost benefit; health economics; inborn errors of metabolism; newborn screening