title: Cost-Effectiveness/Cost-Benefit Analysis of Newborn Screening for Severe Combined Immune Deficiency in Washington State.
abstract: To evaluate the expected cost-effectiveness and net benefit of the recent implementation of newborn screening (NBS) for severe combined immunodeficiency (SCID) in Washington State.
  
  
  
  We constructed a decision analysis model to estimate the costs and benefits of NBS in an annual birth cohort of 86 600 infants based on projections of avoided infant deaths. Point estimates and ranges for input variables, including the birth prevalence of SCID, proportion detected asymptomatically without screening through family history, screening test characteristics, survival rates, and costs of screening, diagnosis, and treatment were derived from published estimates, expert opinion, and the Washington NBS program. We estimated treatment costs stratified by age of identification and SCID type (with or without adenosine deaminase deficiency). Economic benefit was estimated using values of $4.2 and $9.0 million per death averted. We performed sensitivity analyses to evaluate the influence of key variables on the incremental cost-effectiveness ratio (ICER) of net direct cost per life-year saved.
  
  
  
  Our model predicts an additional 1.19 newborn infants with SCID detected preclinically through screening, in addition to those who would have been detected early through family history, and 0.40 deaths averted annually. Our base-case model suggests an ICER of $35 311 per life-year saved, and a benefit-cost ratio of either 5.31 or 2.71. Sensitivity analyses found ICER values <$100 000 and positive net benefit for plausible assumptions on all variables.
  
  
  
  Our model suggests that NBS for SCID in Washington is likely to be cost-effective and to show positive net economic benefit.
authors.affiliation: Association of Public Health Laboratories, Newborn Screening and Genetics, Silver Spring, MD.
authors.forename: Yao
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Washington State Department of Health, Office of Newborn Screening, Shoreline, WA.
authors.forename: John D
authors.initials: JD
authors.lastname: Thompson
authors.affiliation: Allergy Division, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kobrynski
authors.affiliation: Association of Public Health Laboratories, Newborn Screening and Genetics, Silver Spring, MD.
authors.forename: Jelili
authors.initials: J
authors.lastname: Ojodu
authors.affiliation: Association of Public Health Laboratories, Newborn Screening and Genetics, Silver Spring, MD.
authors.forename: Guisou
authors.initials: G
authors.lastname: Zarbalian
authors.affiliation: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA. Electronic address: sgrosse@cdc.gov.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Grosse
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D007231:Infant, Newborn; D008962:Models, Theoretical; D015997:Neonatal Screening / Q000191:economics*; D012680:Sensitivity and Specificity; D016511:Severe Combined Immunodeficiency / Q000175:diagnosis*; D014861:Washington