Research
The cost-effectiveness of neonatal screening for Cystic Fibrosis: an analysis of alternative scenarios using a decision model
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* Corresponding author: Neil Simpson neil.simpson@banes-pct.nhs.uk
1 Department of Child Health, Newbridge Hill, Bath, BA1 3QE, UK
2 Peninsula Technology Assessment Group (PenTAG) & Institute for Health & Social Care Research, Peninsula Medical School, Universities of Exeter and Plymouth, Plymouth, PL6 8BU, UK
3 Department of Social Policy, The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
4 LSE Health and Social Care, The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
5 Department of Medical Sciences, University of Bath, Bath, BA2 2 BB, UK
6 University of Toronto, Canada. Associate Scientist, Institute of Clinical Evaluative Sciences (ICES), G-214, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
Cost Effectiveness and Resource Allocation 2005, 3:8 doi:10.1186/1478-7547-3-8
Published: 9 August 2005Abstract
Background
The use of neonatal screening for cystic fibrosis is widely debated in the United Kingdom and elsewhere, but the evidence available to inform policy is limited. This paper explores the cost-effectiveness of adding screening for cystic fibrosis to an existing routine neonatal screening programme for congenital hypothyroidism and phenylketonuria, under alternative scenarios and assumptions.
Methods
The study is based on a decision model comparing screening to no screening in terms of a number of outcome measures, including diagnosis of cystic fibrosis, life-time treatment costs, life years and QALYs gained. The setting is a hypothetical UK health region without an existing neonatal screening programme for cystic fibrosis.
Results
Under initial assumptions, neonatal screening (using an immunoreactive trypsin/DNA two stage screening protocol) costs £5,387 per infant diagnosed, or £1.83 per infant screened (1998 costs). Neonatal screening for cystic fibrosis produces an incremental cost-effectiveness of £6,864 per QALY gained, in our base case scenario (an assumed benefit of a 6 month delay in the emergence of symptoms). A difference of 11 months or more in the emergence of symptoms (and mean survival) means neonatal screening is both less costly and produces better outcomes than no screening.
Conclusion
Neonatal screening is expensive as a method of diagnosis. Neonatal screening may be a cost-effective intervention if the hypothesised delays in the onset of symptoms are confirmed. Implementing both antenatal and neonatal screening would undermine potential economic benefits, since a reduction in the birth incidence of cystic fibrosis would reduce the cost-effectiveness of neonatal screening.