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Early Hum Dev. 1996 Jul 19;45(3):257-75.

A cost-effectiveness evaluation of newborn hemoglobinopathy screening from the perspective of state health care systems.

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  • 1Alaska Division of Public Health, Section of Epidemiology, Anchorage 99501, USA.

Abstract

OBJECTIVE:

To determine the most cost-effective strategy for newborn hemoglobinopathy screening from the perspective of state health care systems.

STUDY DESIGN:

Using Alaska as an example, we used decision analysis to compare a policy of no screening to universal or targeted screening with selective follow-up only of infants who are homozygous or compound heterozygous for an abnormal hemoglobin variant and to universal or targeted screening with complete follow-up, including follow-up of infants with clinically insignificant traits. Probabilities and costs were varied over values that might be expected for other states.

RESULTS:

Among the selective follow-up options, targeted screening would be the most cost-effective strategy for Alaska at a cost of $206,192 per death averted; by contrast, universal screening would prevent 50% more deaths at an incremental cost of $2,040,000 per death averted. Universal would be more cost-effective than targeted screening for several scenarios expected to occur in other states, including a high sickle cell disease prevalence, a low screening test cost, and a high cost per screen associated with racial targeting. Among the complete follow-up options, both targeted and universal screening would cost at least $200,000 per death averted over the range of all variables tested during sensitivity analysis; the incremental cost of universal versus targeted screening would be at least $600,000 per death averted.

CONCLUSIONS:

Our data suggest each state should determine the most cost-effective option based on state-specific values for sickle cell disease prevalence, test costs and racial targeting costs.

PMID:
8855399
[PubMed - indexed for MEDLINE]
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