title: A Cost-Effectiveness Analysis of a Pilot Neonatal Screening Program for Sickle Cell Anemia in the Republic of Angola.
abstract: OBJECTIVE
  To assess the cost-effectiveness of a pilot newborn screening (NBS) and treatment program for sickle cell anemia (SCA) in Luanda, Angola.
  
  
  METHODS
  In July 2011, a pilot NBS and treatment program was implemented in Luanda, Angola. Infants identified with SCA were enrolled in a specialized SCA clinic in which they received preventive care and sickle cell education. In this analysis, the World Health Organization (WHO) and generalized cost-effectiveness analysis methods were used to estimate gross intervention costs of the NBS and treatment program. To determine healthy life-years (HLYs) gained by screening and treatment, we assumed NBS reduced mortality to that of the Angolan population during the first 5 years based upon WHO and Global Burden of Diseases Study 2010 estimates, but provided no significant survival benefit for children who survive through age 5 years. A secondary sensitivity analysis with more conservative estimates of mortality benefits also was performed. The costs of downstream medical costs, including acute care, were not included.
  
  
  RESULTS
  Based upon the costs of screening 36,453 infants and treating the 236 infants with SCA followed after NBS in the pilot project, NBS and treatment program is projected to result in the gain of 452-1105 HLYs, depending upon the discounting rate and survival assumptions used. The corresponding estimated cost per HLY gained is $1380-$3565, less than the gross domestic product per capita in Angola.
  
  
  CONCLUSIONS
  These data demonstrate that NBS and treatment for SCA appear to be highly cost-effective across all scenarios for Angola by the WHO criteria.
authors.affiliation: Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Patrick T
authors.initials: PT
authors.lastname: McGann
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Grosse
authors.affiliation: Centro de Apoio ao Doente Anémico, Hospital Pediátrico David Bernardino, Luanda, Angola.
authors.forename: Brigida
authors.initials: B
authors.lastname: Santos
authors.affiliation: Centro de Apoio ao Doente Anémico, Hospital Pediátrico David Bernardino, Luanda, Angola.
authors.forename: Vysolela
authors.initials: V
authors.lastname: de Oliveira
authors.affiliation: Centro de Apoio ao Doente Anémico, Hospital Pediátrico David Bernardino, Luanda, Angola.
authors.forename: Luis
authors.initials: L
authors.lastname: Bernardino
authors.affiliation: Institute for Health Metrics and Evaluation, Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital and University of Washington, Seattle, WA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Kassebaum
authors.affiliation: Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Russell E
authors.initials: RE
authors.lastname: Ware
authors.affiliation: Texas Children's Cancer and Hematology Centers and Department of Pediatrics, Baylor College of Medicine, Houston, TX. Electronic address: gairewele@txch.org.
authors.forename: Gladstone E
authors.initials: GE
authors.lastname: Airewele
mesh_terms: D000755:Anemia, Sickle Cell / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D000810:Angola / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008297:Male; D009017:Morbidity / Q000639:trends; D015997:Neonatal Screening / Q000191:economics*; D010865:Pilot Projects