Zeuner, Dagmar; (1999) Cost-effectiveness analysis of antenatal and neonatal haemoglobinopathy screening in the UK. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Objectives To compare the cost-effectiveness of universal and selective antenatal and neonatal haemoglobinopathy screening. Methods The effectiveness of screening was measured by the number of women with affected fetuses offered reproductive choice (antenatal), and by the number of late diagnoses of sickle cell disease prevented (neonatal). A decision model was developed and applied to the antenatal ethnic group distribution in each health district in the UK, and an incremental cost-effectiveness analysis carried out. Sensitivity analyses identified parameters most influential on choice of antenatal and neonatal strategy. It was assumed decision makers would regard it cost-effective to spend £50,000- £150,000 to offer an additional woman reproductive choice, and £10,000-£50,000 to prevent an additional late diagnosis of sickle cell disease. Results Selective screening on the basis of ethnicity, both antenatal and neonatal, was highly cost-effective compared to no screening in all districts. Universal antenatal screening would be cost-effective in districts with a fetal sickle cell disease prevalence above 5-12 per 10,000 pregnant women and neonatal above 7-18 respectively. Fetal prevalence exceeds these levels in approximately 1-9% of districts. As screening of North European women/newborns is not, in itself, cost-effective, the rationale for universal screening lies in the presumed higher coverage among non-North European women and their newborns. Higher uptake of prenatal diagnosis would decrease the need for universal neonatal screening, but selective neonatal screening would remain cost-effective in all districts compared to no screening. Conclusions Explicit universal or selective antenatal and neonatal screening policies should be adopted by all districts. Reduction of differential coverage between universal and selective programmes is required to minimise inequity of service provision.

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