TY - JOUR
T1 - Neonatal screening for sickle cell disease
T2 - A cost-effectiveness analysis
AU - Tsevat, Joel
AU - Wong, John B.
AU - Pauker, Stephen G.
AU - Steinberg, Martin H.
N1 - Funding Information:
Supported in part by grants LM7044, LM4022, and LM3374 from the National Library of Medicine and by research funds of the Veterans Administration. Submitted for publication Sept. 11', 1990; accepted Nov. 19, 1990. Reprint requests: Stephen G. Pauker, MD, Division of Clinical Decision Making, Box 302, New England Medical Center, 750 Washington St., Boston, MA 021! 1. *Now at the Department of Medicine, Beth Israel Hospital and Harvard Medical School, Boston, Mass. 9/20/26861 A sound rationale underlies the belief that neonatal screening for sickle cell anemia and other severe sickling hemoglobinopathies may save the lives of affected infants. In the first 3 years of life, children with sickle cell disease are at great risk of infection with Streptococcus pneumoniae, which has a case-fatality rate as high as 30%. ~'13 Recent trials of prophylactic use of penicillin, though, have demonstrated reductions in the incidence of S. pneumoniae sepsis and in the associated mortality rate in patients less than 3
PY - 1991/4
Y1 - 1991/4
N2 - Purpose: To determine the cost-effectiveness of screening newborn infants for sickle cell disease. Design: We developed a decision model that examined two strategies: (1) screening neonates and administering penicillin to infants found to have sickle cell disease in the the hope of preventing pneumococcal sepsis, and (2) not screening but administering penicillin to infants after symptoms of sickle cell disease develop. The model calculates the cost-effectiveness of these strategies during the first 3 years of life. We applied the model to three prototypic populations of neonates-black, nonblack with a relatively high prevalence of hemoglobin S genes, and nonblack with a low prevalence of hemoglobin S genes. Data identification: We obtained from the published literature the effectiveness and risk of penicillin prophylaxis, the risk of pneumococcal sepsis, and the probability that in infants not screened the development of symptoms would lead to the discovery of sickle cell disease within the first 3 years of life; we used the published literature and the Hardy-Weinberg law to determine the prevalence of sickle cell disease. We used actual variable costs of screening, antibiotic prophylaxis, and hospitalization for pneumococcal sepsis or anaphylaxis. Results: Screening and then treating affected black infants costs only $3100 more per life saved than not screening. Screening nonblack populations with a high prevalence of hemoglobin S genes would cost $1.4 million per life saved, and screening low prevalence populations would cost $450 billion per life saved. Conclusions: Screening black infants is very worthwhile, but screening populations in which the hemoglobin S gene is rare is unjustified.
AB - Purpose: To determine the cost-effectiveness of screening newborn infants for sickle cell disease. Design: We developed a decision model that examined two strategies: (1) screening neonates and administering penicillin to infants found to have sickle cell disease in the the hope of preventing pneumococcal sepsis, and (2) not screening but administering penicillin to infants after symptoms of sickle cell disease develop. The model calculates the cost-effectiveness of these strategies during the first 3 years of life. We applied the model to three prototypic populations of neonates-black, nonblack with a relatively high prevalence of hemoglobin S genes, and nonblack with a low prevalence of hemoglobin S genes. Data identification: We obtained from the published literature the effectiveness and risk of penicillin prophylaxis, the risk of pneumococcal sepsis, and the probability that in infants not screened the development of symptoms would lead to the discovery of sickle cell disease within the first 3 years of life; we used the published literature and the Hardy-Weinberg law to determine the prevalence of sickle cell disease. We used actual variable costs of screening, antibiotic prophylaxis, and hospitalization for pneumococcal sepsis or anaphylaxis. Results: Screening and then treating affected black infants costs only $3100 more per life saved than not screening. Screening nonblack populations with a high prevalence of hemoglobin S genes would cost $1.4 million per life saved, and screening low prevalence populations would cost $450 billion per life saved. Conclusions: Screening black infants is very worthwhile, but screening populations in which the hemoglobin S gene is rare is unjustified.
UR - https://www.scopus.com/pages/publications/0025727755
UR - https://www.scopus.com/pages/publications/0025727755#tab=citedBy
U2 - 10.1016/S0022-3476(05)83375-X
DO - 10.1016/S0022-3476(05)83375-X
M3 - Article
C2 - 1901081
AN - SCOPUS:0025727755
SN - 0022-3476
VL - 118
SP - 546
EP - 554
JO - The Journal of pediatrics
JF - The Journal of pediatrics
IS - 4 PART 1
ER -