Elsevier

The Journal of Pediatrics

Volume 136, Issue 2, February 2000, Pages 201-208
The Journal of Pediatrics

Universal versus targeted screening of infants for sickle cell disease: A cost-effectiveness analysis,☆☆,

https://doi.org/10.1016/S0022-3476(00)70102-8Get rights and content

Abstract

Objective: To compare the health outcomes, costs, and incremental cost-effectiveness of universal neonatal screening for sickle cell disease (SCD) with screening targeted to African Americans. Study design: A cost-effectiveness analysis was done by using a Markov simulation model that considered the costs and outcomes associated with the prevention and treatment of sepsis in those with sickle cell anemia and sickle β0-thalassemia. Three strategies were compared: (1) no screening, (2) targeted screening of African Americans, and (3) universal screening for SCD. Results: In the base case analysis, targeted screening of African Americans compared with no screening cost $6709 per additional year of life saved, and universal screening compared with targeted screening cost $30,760 per additional year of life saved. In a sensitivity analysis, the cost per additional year of life saved with universal screening compared with targeted screening was positively correlated with the delivery rate of targeted screening and was inversely related to the proportion of African Americans in the population. Conclusions: Targeted screening of African American newborns for SCD compared with no screening is always cost-effective. Universal screening compared with targeted screening always identifies more infants with disease, prevents more deaths, and is cost-effective given certain delivery rates for targeted screening and proportions of African Americans in the population. (J Pediatr 2000;136;201-8)

Section snippets

Structure of the Decision Model

Three newborn screening strategies for SCD were compared: (1) no screening, (2) targeted screening of African Americans, and (3) universal screening. Infants screened in the targeted screening or universal screening strategies had a confirmatory test if the screening test result was positive. Patients with SCD identified through screening (“SCD identified”) were treated with prophylactic penicillin and referred for parental education and comprehensive care. Patients with SCD who were not

Base-Case Analysis: Health Outcomes and Costs

Table III shows the number of infants screened, cases of SCD identified, total deaths, and total costs for each of the 3 strategies applied to a hypothetical cohort of 1,000,000 infants.

. Baseline results

StrategyInfants screened per 1,000,000Total costs discountedTotal cases identifiedTotal deaths
No screening0$418,812013
Targeted screening of African Americans296,000*1,398,3883167
Universal screening990,0002,690,3074045
*Assumes 80% of African Americans and 20% of non-African Americans screened at

DISCUSSION

Our analysis compared health outcomes, costs, and incremental cost-effectiveness of universal screening for SCD with screening targeted to African Americans. We found that targeted screening compared with no screening was always cost-effective. Universal screening compared with targeted screening always identifies more infants with disease and prevents more deaths but incurs greater dollar cost.

Results of the sensitivity analysis showed the powerful influence of 2 factors, the proportion of

Acknowledgements

We thank Mr James McKinna for providing the screening cost data, Ms Marva Houston for providing follow-up educational and counseling costs, and Dr Robert Mauro for insightful suggestions.

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    Dr Panepinto is now a member of The Department of Pediatric Hematology/Oncology, Brown University School of Medicine, Providence, Rhode Island.

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    Reprint requests: Peter A. Lane, MD, University of Colorado Health Sciences Center, Campus Box C222, 4200 East Ninth Ave, Denver, CO 80262.

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