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Universal versus targeted screening of infants for sickle cell disease: a cost-effectiveness analysis
J A Panepinto1, D Magid, M J Rewers
1Colorado Sickle Cell Treatment and Research Center and the Departments of Pediatrics and Preventive Medicine and Biometrics, University of Colorado School of Medicine, Denver, CO 80262, USA.
Insights
Targeted newborn screening for sickle cell disease (SCD) in African Americans is cost-effective. Universal screening for SCD also proves cost-effective under specific conditions, identifying more infants and preventing deaths.
Area of Science:
- Public Health
- Genetics
- Health Economics
Background:
- Sickle cell disease (SCD) disproportionately affects African Americans.
- Neonatal screening aims to detect SCD early for timely intervention.
- Current screening strategies vary, prompting analysis of cost-effectiveness.
Purpose of the Study:
- To compare the health outcomes, costs, and cost-effectiveness of universal neonatal screening for SCD versus screening targeted to African Americans.
- To evaluate the economic implications of different SCD screening approaches.
Main Methods:
- A cost-effectiveness analysis was conducted using a Markov simulation model.
- The model incorporated costs and outcomes related to sepsis prevention and treatment in individuals with sickle cell anemia and sickle beta(0)-thalassemia.
- Three strategies were compared: no screening, targeted screening of African Americans, and universal screening for SCD.
Main Results:
- Targeted screening of African Americans was cost-effective compared to no screening ($6709 per year of life saved).
- Universal screening was more costly than targeted screening ($30,760 per year of life saved).
- Sensitivity analysis indicated universal screening's cost-effectiveness is influenced by targeted screening delivery rates and population demographics.
Conclusions:
- Targeted screening for SCD in African American newborns is consistently cost-effective.
- Universal screening identifies more affected infants and prevents more deaths.
- Universal screening is cost-effective when targeted screening delivery rates and the proportion of African Americans in the population meet certain thresholds.
Objective:
To compare the health outcomes, costs, and incremental cost-effectiveness of universal neonatal screening for sickle cell disease (SCD) with screening targeted to African Americans.
Study Design:
A cost-effectiveness analysis was done by using a Markov simulation model that considered the costs and outcomes associated with the prevention and treatment of sepsis in those with sickle cell anemia and sickle beta(0)-thalassemia. Three strategies were compared: (1) no screening, (2) targeted screening of African Americans, and (3) universal screening for SCD.
Results:
In the base case analysis, targeted screening of African Americans compared with no screening cost $6709 per additional year of life saved, and universal screening compared with targeted screening cost $30,760 per additional year of life saved. In a sensitivity analysis, the cost per additional year of life saved with universal screening compared with targeted screening was positively correlated with the delivery rate of targeted screening and was inversely related to the proportion of African Americans in the population.
Conclusions:
Targeted screening of African American newborns for SCD compared with no screening is always cost-effective. Universal screening compared with targeted screening always identifies more infants with disease, prevents more deaths, and is cost-effective given certain delivery rates for targeted screening and proportions of African Americans in the population.
