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Is universal neonatal hemoglobinopathy screening cost-effective?
R H Sprinkle1, D M Hynes, T R Konrad
1Division of Policy and Ethics, Duke University-University of North Carolina Comprehensive Sickle Cell Center, Durham, NC.
Insights
Universal neonatal screening for hemoglobinopathies, like sickle-cell disease, can be cost-effective. Cooperative screening arrangements can improve economic viability for states, ensuring broader access to essential health checks.
Area of Science:
- Public Health
- Genetics
- Health Economics
Background:
- Neonatal screening programs are crucial for early detection of genetic disorders.
- Hemoglobinopathies, particularly sickle-cell disease, represent a significant public health concern.
- Current screening practices vary across states, impacting accessibility and cost-effectiveness.
Purpose of the Study:
- To evaluate the economic feasibility of universal neonatal screening for hemoglobinopathies.
- To compare the cost-effectiveness of universal sickle-cell disease screening with phenylketonuria screening.
- To explore the potential of screening cooperatives to reduce costs in high-cost states.
Main Methods:
- Cost-effectiveness projections for nonuniversal and universal screening models.
- Comparative analysis of sickle-cell disease and phenylketonuria screening costs.
- Modeling of cooperative screening arrangements between demographically complementary states.
Main Results:
- Universal screening adoption is projected to increase in some states if cost-effectiveness thresholds are met.
- Several states currently performing screening might discontinue it independently but could benefit from cooperatives.
- Economies of scale are achievable through cooperative screening, reducing average costs for detecting hemoglobinopathies and phenylketonuria.
Conclusions:
- Universal neonatal screening for hemoglobinopathies is achievable at socially acceptable costs.
- Cooperative screening models enhance cost-effectiveness, particularly for diverse demographic states.
- Optimizing screening strategies through collaboration can ensure wider access to vital genetic disorder detection.
Objective:
To determine whether and where universal neonatal screening for hemoglobinopathies, chiefly sickle-cell disease, could be performed at socially acceptable costs.
Methods:
We made projections of the cost-effectiveness of nonuniversal and universal sickle-cell disease screening throughout the United States. We then compared the cost-effectiveness of universal sickle-cell disease screening with that of universal phenylketonuria screening. Finally, we asked if "high-cost" states, that is, those in which the cost of finding a case of sickle-cell disease exceeded one half the cost of finding a case of phenylketonuria, could enhance their cost-effectiveness by joining demographically complementary states in screening cooperatives.
Results:
If all states conducted independent screening and if the value of finding a case of sickle-cell disease were no more than one half that of finding a case of phenylketonuria, seven of the 19 states that do not currently conduct universal screening for hemoglobinopathies would begin to do so, but six of the 34 that currently do so would stop. Of the six that would stop, three have already formed a screening cooperative, reducing their projected average costs for finding either sickle-cell disease or phenylketonuria or both; the other three could similarly improve cost-effectiveness through cooperative arrangements. Nineteen states realize economies of scale in six cooperative groups; more could do so.
Conclusion:
Universal neonatal hemoglobinopathy screening can be made available at socially acceptable costs to the citizens of demographically various states.