The Economic Impact of Premarital Screening (PMS) of Sickle Cell Anemia on the Saudi Health System: A Cost Analysis...

Background: In Saudi Arabia, the government has implemented compulsory premarital screening and consultations for high-risk and positive sickle cell results (traits = AS gene and disease = SS gene). However, despite these measures being in place since 2004, there are still cases of children being born with sickle cell disease. This study aims to evaluate the costs associated with the government's mandatory premarital screening for sickle cell anemia, compare these expenses with those incurred due to high-risk marriages and analyze the government's healthcare spending on sickle cell anemia management. Method: A decision tree model was conceptualized for the purpose of this study to identify the possible paths from the premarital screening (PMS) procedure. A total of 300,000 cases were processed through this decision tree model. Results: The annual management costs for children with the probability of having sickle cell disease are estimated to be USD 10,746,450 in the screening arm and USD 40,488,000 in the no-screening arm. These costs vary depending on the genetic combination of the parents. For individuals with the SS/SS gene combination, the estimated cost is USD 8,137,800 per year. When parents have the SS/AS gene combination, the estimated cost is USD 2,071,950 annually. For those with the sickle cell trait combination (AS/AS), the cost is estimated to be USD 536,700 per year. A direct comparison shows a modeled PMS incremental cost is estimated at USD 29,741,550, which is approximately a 73% reduction in healthcare costs. Conclusions: The premarital screening for sickle cell disease is not only cost-saving but also shows the potential for significantly reducing healthcare spending related to sickle cell disease in the future.