Patrick T McGann1, Scott D Grosse2, Brigida Santos3, Vysolela de Oliveira3, Luis Bernardino3, Nicholas J Kassebaum4, Russell E Ware1, Gladstone E Airewele5. 1. Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 2. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA. 3. Centro de Apoio ao Doente Anémico, Hospital Pediátrico David Bernardino, Luanda, Angola. 4. Institute for Health Metrics and Evaluation, Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital and University of Washington, Seattle, WA. 5. Texas Children's Cancer and Hematology Centers and Department of Pediatrics, Baylor College of Medicine, Houston, TX. Electronic address: gairewele@txch.org.
Abstract
OBJECTIVE: To assess the cost-effectiveness of a pilot newborn screening (NBS) and treatment program for sickle cell anemia (SCA) in Luanda, Angola. STUDY DESIGN: In July 2011, a pilot NBS and treatment program was implemented in Luanda, Angola. Infants identified with SCA were enrolled in a specialized SCA clinic in which they received preventive care and sickle cell education. In this analysis, the World Health Organization (WHO) and generalized cost-effectiveness analysis methods were used to estimate gross intervention costs of the NBS and treatment program. To determine healthy life-years (HLYs) gained by screening and treatment, we assumed NBS reduced mortality to that of the Angolan population during the first 5 years based upon WHO and Global Burden of Diseases Study 2010 estimates, but provided no significant survival benefit for children who survive through age 5 years. A secondary sensitivity analysis with more conservative estimates of mortality benefits also was performed. The costs of downstream medical costs, including acute care, were not included. RESULTS: Based upon the costs of screening 36,453 infants and treating the 236 infants with SCA followed after NBS in the pilot project, NBS and treatment program is projected to result in the gain of 452-1105 HLYs, depending upon the discounting rate and survival assumptions used. The corresponding estimated cost per HLY gained is $1380-$3565, less than the gross domestic product per capita in Angola. CONCLUSIONS: These data demonstrate that NBS and treatment for SCA appear to be highly cost-effective across all scenarios for Angola by the WHO criteria.
OBJECTIVE: To assess the cost-effectiveness of a pilot newborn screening (NBS) and treatment program for sickle cell anemia (SCA) in Luanda, Angola. STUDY DESIGN: In July 2011, a pilot NBS and treatment program was implemented in Luanda, Angola. Infants identified with SCA were enrolled in a specialized SCA clinic in which they received preventive care and sickle cell education. In this analysis, the World Health Organization (WHO) and generalized cost-effectiveness analysis methods were used to estimate gross intervention costs of the NBS and treatment program. To determine healthy life-years (HLYs) gained by screening and treatment, we assumed NBS reduced mortality to that of the Angolan population during the first 5 years based upon WHO and Global Burden of Diseases Study 2010 estimates, but provided no significant survival benefit for children who survive through age 5 years. A secondary sensitivity analysis with more conservative estimates of mortality benefits also was performed. The costs of downstream medical costs, including acute care, were not included. RESULTS: Based upon the costs of screening 36,453 infants and treating the 236 infants with SCA followed after NBS in the pilot project, NBS and treatment program is projected to result in the gain of 452-1105 HLYs, depending upon the discounting rate and survival assumptions used. The corresponding estimated cost per HLY gained is $1380-$3565, less than the gross domestic product per capita in Angola. CONCLUSIONS: These data demonstrate that NBS and treatment for SCA appear to be highly cost-effective across all scenarios for Angola by the WHO criteria.
Authors: Christopher J L Murray; Majid Ezzati; Abraham D Flaxman; Stephen Lim; Rafael Lozano; Catherine Michaud; Mohsen Naghavi; Joshua A Salomon; Kenji Shibuya; Theo Vos; Daniel Wikler; Alan D Lopez Journal: Lancet Date: 2012-12-15 Impact factor: 79.321
Authors: Li Liu; Hope L Johnson; Simon Cousens; Jamie Perin; Susana Scott; Joy E Lawn; Igor Rudan; Harry Campbell; Richard Cibulskis; Mengying Li; Colin Mathers; Robert E Black Journal: Lancet Date: 2012-05-11 Impact factor: 79.321
Authors: Joshua A Salomon; Theo Vos; Daniel R Hogan; Michael Gagnon; Mohsen Naghavi; Ali Mokdad; Nazma Begum; Razibuzzaman Shah; Muhammad Karyana; Soewarta Kosen; Mario Reyna Farje; Gilberto Moncada; Arup Dutta; Sunil Sazawal; Andrew Dyer; Jason Seiler; Victor Aboyans; Lesley Baker; Amanda Baxter; Emelia J Benjamin; Kavi Bhalla; Aref Bin Abdulhak; Fiona Blyth; Rupert Bourne; Tasanee Braithwaite; Peter Brooks; Traolach S Brugha; Claire Bryan-Hancock; Rachelle Buchbinder; Peter Burney; Bianca Calabria; Honglei Chen; Sumeet S Chugh; Rebecca Cooley; Michael H Criqui; Marita Cross; Kaustubh C Dabhadkar; Nabila Dahodwala; Adrian Davis; Louisa Degenhardt; Cesar Díaz-Torné; E Ray Dorsey; Tim Driscoll; Karen Edmond; Alexis Elbaz; Majid Ezzati; Valery Feigin; Cleusa P Ferri; Abraham D Flaxman; Louise Flood; Marlene Fransen; Kana Fuse; Belinda J Gabbe; Richard F Gillum; Juanita Haagsma; James E Harrison; Rasmus Havmoeller; Roderick J Hay; Abdullah Hel-Baqui; Hans W Hoek; Howard Hoffman; Emily Hogeland; Damian Hoy; Deborah Jarvis; Ganesan Karthikeyan; Lisa Marie Knowlton; Tim Lathlean; Janet L Leasher; Stephen S Lim; Steven E Lipshultz; Alan D Lopez; Rafael Lozano; Ronan Lyons; Reza Malekzadeh; Wagner Marcenes; Lyn March; David J Margolis; Neil McGill; John McGrath; George A Mensah; Ana-Claire Meyer; Catherine Michaud; Andrew Moran; Rintaro Mori; Michele E Murdoch; Luigi Naldi; Charles R Newton; Rosana Norman; Saad B Omer; Richard Osborne; Neil Pearce; Fernando Perez-Ruiz; Norberto Perico; Konrad Pesudovs; David Phillips; Farshad Pourmalek; Martin Prince; Jürgen T Rehm; Guiseppe Remuzzi; Kathryn Richardson; Robin Room; Sukanta Saha; Uchechukwu Sampson; Lidia Sanchez-Riera; Maria Segui-Gomez; Saeid Shahraz; Kenji Shibuya; David Singh; Karen Sliwa; Emma Smith; Isabelle Soerjomataram; Timothy Steiner; Wilma A Stolk; Lars Jacob Stovner; Christopher Sudfeld; Hugh R Taylor; Imad M Tleyjeh; Marieke J van der Werf; Wendy L Watson; David J Weatherall; Robert Weintraub; Marc G Weisskopf; Harvey Whiteford; James D Wilkinson; Anthony D Woolf; Zhi-Jie Zheng; Christopher J L Murray; Jost B Jonas Journal: Lancet Date: 2012-12-15 Impact factor: 79.321
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Roy Burstein; Bianca Calabria; Benjamin Campbell; Charles E Canter; Hélène Carabin; Jonathan Carapetis; Loreto Carmona; Claudia Cella; Fiona Charlson; Honglei Chen; Andrew Tai-Ann Cheng; David Chou; Sumeet S Chugh; Luc E Coffeng; Steven D Colan; Samantha Colquhoun; K Ellicott Colson; John Condon; Myles D Connor; Leslie T Cooper; Matthew Corriere; Monica Cortinovis; Karen Courville de Vaccaro; William Couser; Benjamin C Cowie; Michael H Criqui; Marita Cross; Kaustubh C Dabhadkar; Manu Dahiya; Nabila Dahodwala; James Damsere-Derry; Goodarz Danaei; Adrian Davis; Diego De Leo; Louisa Degenhardt; Robert Dellavalle; Allyne Delossantos; Julie Denenberg; Sarah Derrett; Don C Des Jarlais; Samath D Dharmaratne; Mukesh Dherani; Cesar Diaz-Torne; Helen Dolk; E Ray Dorsey; Tim Driscoll; Herbert Duber; Beth Ebel; Karen Edmond; Alexis Elbaz; Suad Eltahir Ali; Holly Erskine; Patricia J Erwin; Patricia Espindola; Stalin E Ewoigbokhan; Farshad Farzadfar; Valery Feigin; David T Felson; Alize Ferrari; Cleusa P Ferri; Eric M Fèvre; Mariel M Finucane; Seth Flaxman; Louise Flood; Kyle Foreman; Mohammad H Forouzanfar; Francis Gerry R Fowkes; Marlene Fransen; Michael K Freeman; Belinda J Gabbe; Sherine E Gabriel; Emmanuela Gakidou; Hammad A Ganatra; Bianca Garcia; Flavio Gaspari; Richard F Gillum; Gerhard Gmel; Diego Gonzalez-Medina; Richard Gosselin; Rebecca Grainger; Bridget Grant; Justina Groeger; Francis Guillemin; David Gunnell; Ramyani Gupta; Juanita Haagsma; Holly Hagan; Yara A Halasa; Wayne Hall; Diana Haring; Josep Maria Haro; James E Harrison; Rasmus Havmoeller; Roderick J Hay; Hideki Higashi; Catherine Hill; Bruno Hoen; Howard Hoffman; Peter J Hotez; Damian Hoy; John J Huang; Sydney E Ibeanusi; Kathryn H Jacobsen; Spencer L James; Deborah Jarvis; Rashmi Jasrasaria; Sudha Jayaraman; Nicole Johns; Jost B Jonas; Ganesan Karthikeyan; Nicholas Kassebaum; Norito Kawakami; Andre Keren; Jon-Paul Khoo; Charles H King; Lisa Marie Knowlton; Olive Kobusingye; Adofo Koranteng; Rita Krishnamurthi; Francine Laden; Ratilal Lalloo; Laura L Laslett; Tim Lathlean; Janet L Leasher; Yong Yi Lee; James Leigh; Daphna Levinson; Stephen S Lim; Elizabeth Limb; John Kent Lin; Michael Lipnick; Steven E Lipshultz; Wei Liu; Maria Loane; Summer Lockett Ohno; Ronan Lyons; Jacqueline Mabweijano; Michael F MacIntyre; Reza Malekzadeh; Leslie Mallinger; Sivabalan Manivannan; Wagner Marcenes; Lyn March; David J Margolis; Guy B Marks; Robin Marks; Akira Matsumori; Richard Matzopoulos; Bongani M Mayosi; John H McAnulty; Mary M McDermott; Neil McGill; John McGrath; Maria Elena Medina-Mora; Michele Meltzer; George A Mensah; Tony R Merriman; Ana-Claire Meyer; Valeria Miglioli; Matthew Miller; Ted R Miller; Philip B Mitchell; Charles Mock; Ana Olga Mocumbi; Terrie E Moffitt; Ali A Mokdad; Lorenzo Monasta; Marcella Montico; Maziar Moradi-Lakeh; Andrew Moran; Lidia Morawska; Rintaro Mori; Michele E Murdoch; Michael K Mwaniki; Kovin Naidoo; M Nathan Nair; Luigi Naldi; K M Venkat Narayan; Paul K Nelson; Robert G Nelson; Michael C Nevitt; Charles R Newton; Sandra Nolte; Paul Norman; Rosana Norman; Martin O'Donnell; Simon O'Hanlon; Casey Olives; Saad B Omer; Katrina Ortblad; Richard Osborne; Doruk Ozgediz; Andrew Page; Bishnu Pahari; Jeyaraj Durai Pandian; Andrea Panozo Rivero; Scott B Patten; Neil Pearce; Rogelio Perez Padilla; Fernando Perez-Ruiz; Norberto Perico; Konrad Pesudovs; David Phillips; Michael R Phillips; Kelsey Pierce; Sébastien Pion; Guilherme V Polanczyk; Suzanne Polinder; C Arden Pope; Svetlana Popova; Esteban Porrini; Farshad Pourmalek; Martin Prince; Rachel L Pullan; Kapa D Ramaiah; Dharani Ranganathan; Homie Razavi; Mathilda Regan; Jürgen T Rehm; David B Rein; Guiseppe Remuzzi; Kathryn Richardson; Frederick P Rivara; Thomas Roberts; Carolyn Robinson; Felipe Rodriguez De Leòn; Luca Ronfani; Robin Room; Lisa C Rosenfeld; Lesley Rushton; Ralph L Sacco; Sukanta Saha; Uchechukwu Sampson; Lidia Sanchez-Riera; Ella Sanman; David C Schwebel; James Graham Scott; Maria Segui-Gomez; Saeid Shahraz; Donald S Shepard; Hwashin Shin; Rupak Shivakoti; David Singh; Gitanjali M Singh; Jasvinder A Singh; Jessica Singleton; David A Sleet; Karen Sliwa; Emma Smith; Jennifer L Smith; Nicolas J C Stapelberg; Andrew Steer; Timothy Steiner; Wilma A Stolk; Lars Jacob Stovner; Christopher Sudfeld; Sana Syed; Giorgio Tamburlini; Mohammad Tavakkoli; Hugh R Taylor; Jennifer A Taylor; William J Taylor; Bernadette Thomas; W Murray Thomson; George D Thurston; Imad M Tleyjeh; Marcello Tonelli; Jeffrey A Towbin; Thomas Truelsen; Miltiadis K Tsilimbaris; Clotilde Ubeda; Eduardo A Undurraga; Marieke J van der Werf; Jim van Os; Monica S Vavilala; N Venketasubramanian; Mengru Wang; Wenzhi Wang; Kerrianne Watt; David J Weatherall; Martin A Weinstock; Robert Weintraub; Marc G Weisskopf; Myrna M Weissman; Richard A White; Harvey Whiteford; Natasha Wiebe; Steven T Wiersma; James D Wilkinson; Hywel C Williams; Sean R M Williams; Emma Witt; Frederick Wolfe; Anthony D Woolf; Sarah Wulf; Pon-Hsiu Yeh; Anita K M Zaidi; Zhi-Jie Zheng; 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