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A Cost-Effectiveness Analysis of a Pilot Neonatal Screening Program for Sickle Cell Anemia in the Republic of Angola
Patrick T McGann1, Scott D Grosse2, Brigida Santos3
1Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Newborn screening and treatment for sickle cell anemia in Angola is highly cost-effective, gaining over 450 healthy life-years. This pilot program offers significant public health benefits for infants with SCA.
Area of Science:
- Public Health
- Genetics
- Health Economics
Background:
- Sickle cell anemia (SCA) is a significant health concern.
- Newborn screening (NBS) and early treatment can improve outcomes for infants with SCA.
- The cost-effectiveness of such programs in low-resource settings like Angola is crucial to assess.
Purpose of the Study:
- To evaluate the cost-effectiveness of a pilot newborn screening and treatment program for sickle cell anemia in Luanda, Angola.
- To determine the number of healthy life-years (HLYs) gained through the intervention.
- To compare the cost per HLY gained against Angola's gross domestic product (GDP) per capita.
Main Methods:
- A pilot NBS and treatment program for SCA was implemented in Luanda, Angola, starting in July 2011.
- World Health Organization (WHO) and generalized cost-effectiveness analysis methods were employed.
- Estimated gross intervention costs and HLYs gained, assuming NBS reduced mortality in the first five years.
Main Results:
- The pilot program screened 36,453 infants and treated 236 infants with SCA.
- The NBS and treatment program is projected to gain 452-1105 HLYs.
- The estimated cost per HLY gained ranged from $1380-$3565, which is below Angola's GDP per capita.
Conclusions:
- Newborn screening and treatment for SCA demonstrate high cost-effectiveness in Angola based on WHO criteria.
- The program offers a valuable public health intervention for SCA in the region.
- These findings support the expansion of NBS and treatment programs for SCA in similar settings.
Objective:
To assess the cost-effectiveness of a pilot newborn screening (NBS) and treatment program for sickle cell anemia (SCA) in Luanda, Angola.
Study Design:
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.