Organisation and cost-effectiveness of antenatal haemoglobinopathy screening and follow up in a community-based programme.

OBJECTIVE: To consider the organisation cost and effectiveness, of universal, community-based antenatal screening for the haemoglobinopathies, and to estimate the cost-effectiveness of programmes at different levels of prevalence and mix of haemoglobinopathy traits.
DESIGN: Retrospective review of laboratory and Sickle Cell and Thalassaemia Centre worksheets with costing of capital equipment, consumables, salaries and overheads, and estimation of costs in a range of circumstances.
SETTING: A haematology department, including a Sickle Cell and Thalassaemia Centre, providing antenatal and neonatal screening programmes in Inner London. PARTICIPANTS: Two thousand one hundred and one women booking at the antenatal clinic whose samples were referred for screening during 1994. MAIN OUTCOME MEASURES AND
RESULTS: In addition to assessing the cost-effectiveness of antenatal haemoglobinopathy screening in a number of settings, the following specific financial information was assembled for the service in Brent: 1. cost of identifying abnormal haemoglobin in mother (ł209); 2. cost of identifying at-risk fetus before confirmation by prenatal diagnosis (ł2,455); 3. cost of providing genetic information and counselling to mother with abnormal haemoglobin (ł109); 4. programme savings from cases averted (ł61,000). Conclusions Antenatal screening with follow up counselling can be self-financing at most prevalences of haemoglobinopathy traits, with greater savings where a high proportion of the traits are beta thalassaemia. There is a net financial cost (ł1,350) only at prevalences below 2.5% of traits if these are mainly for sickle cell disease. Since there are other benefits is it likely that antenatal screening will be considered cost-effective even at quite low levels of trait prevalence.