Probabilistic Sensitivity Analysis of Thalassemia Screening Cascade Efficiency: Single-Sample Versus Multivisit...

Area of Science:

• Public Health
• Health Economics
• Genetics

Background:

• Malaysia's national thalassemia screening faces a 20% dropout rate, impacting rural populations.
• Current protocol involves multiple visits, contributing to high attrition.
• Protocol 2 offers a single-visit, three-tier testing approach to improve efficiency.

Purpose of the Study:

• To evaluate the cost-effectiveness of a new single-visit thalassemia screening protocol (Protocol 2) compared to the existing multi-visit protocol (Protocol 1).
• To quantify parameter uncertainty using probabilistic sensitivity analysis for thalassemia screening in Malaysia.
• To assess the probability of Protocol 2 being cost-effective across various willingness-to-pay thresholds.

Main Methods:

• Probabilistic sensitivity analysis using Monte Carlo simulations (10,000 iterations) on administrative data from 65,990 students in Sabah and Sarawak.
• Probability distributions assigned to costs and dropout rates.
• Cost-effectiveness acceptability curves generated to estimate probabilities at MYR 10-50 willingness-to-pay thresholds.

Main Results:

• Protocol 2 demonstrated favorable incremental cost-effectiveness ratios (Sabah: MYR 20.8; Sarawak: MYR 10.3) with narrow credible intervals.
• Protocol 2 showed a >91% probability of cost-effectiveness in Sabah and ~100% in Sarawak at MYR 25-50 thresholds.
• Even under pessimistic dropout scenarios (5%), Protocol 2 maintained ≥70% probability of cost-effectiveness.

Conclusions:

• Protocol 2 offers a more efficient and potentially cost-effective thalassemia screening strategy in Malaysia.
• The single-visit approach significantly reduces dropout rates, particularly benefiting underserved populations.
• Findings support further evaluation and implementation of Protocol 2 for improved public health outcomes.