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Br J Gen Pract. 2011 Oct;61(591):e620-7. doi: 10.3399/bjgp11X601325.

Screening for sickle cell and thalassaemia in primary care: a cost-effectiveness study.

Author information

  • 1Health Economics Unit, University of Birmingham. stirling.bryan@ubc.ca

Abstract

BACKGROUND:

Haemoglobinopathies, including sickle cell disease and thalassaemia (SCT), are inherited disorders of haemoglobin. Antenatal screening for SCT rarely occurs before 10 weeks of pregnancy.

AIM:

To explore the cost-effectiveness of offering SCT screening in a primary care setting, during the pregnancy confirmation visit.

DESIGN AND SETTING:

A model-based cost-effectiveness analysis of inner-city areas with a high proportion of residents from ethnic minority groups.

METHOD:

Comparison was made of three SCT screening approaches: 'primary care parallel' (primary care screening with test offered to mother and father together); 'primary care sequential (primary care screening with test offered to the mother and then the father only if the mother is a carrier); and 'midwife care' (sequential screening at the first midwife consultation). The model was populated with data from the SHIFT (Screening for Haemoglobinopathies In First Trimester) trial and other sources.

RESULTS:

Compared to midwife care, primary care sequential had a higher NHS cost of £34,000 per 10,000 pregnancies (95% confidence interval [CI] = £15,000 to £51,000) and an increase of 2623 women screened (95% CI: 1359 to 4495), giving a cost per additional woman screened by 10 weeks of £13. Primary care parallel was dominated by primary care sequential, with both higher costs and fewer women screened.

CONCLUSION:

The policy judgement is whether an earlier opportunity for informed reproductive choice has a value of at least £13. Further work is required to understand the value attached to earlier informed reproductive choices.

PMID:
22152833
[PubMed - indexed for MEDLINE]
PMCID:
PMC3177130
Free PMC Article
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