Screening for sickle cell and thalassaemia in primary care: A cost-effectiveness study

Stirling Bryan, Elizabeth Dormandy, Tracy Roberts, Anthony Ades, Pelham Barton, Ariadna Juárez-García, Lazaros Andronis, Jonathan Karnon, Theresa Mary Marteau

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Abstract

Background: Haemoglobinopathies, including sickle cell disease and thalassaemia (SCT), are inherited disorders of haemoglobin. Antenatal screening for SCT rarely occurs before 10 weeks of pregnancy. Aim: To explore the cost-effectiveness of offering SCT screening in a primary care setting, during the pregnancy confirmation visit. Design and setting: A model-based cost-effectiveness analysis of inner-city areas with a high proportion of residents fromethnicminority groups. Method: Comparison was made of three SCT screening approaches: 'primary care parallel' (primary care screening with test offered tomother and father together); 'primary care sequential'(primary care screening with test offered to the mother and then the father only if themother is a carrier); and 'midwife care' (sequential screening at the first midwife consultation). The model was populated with data from the SHIFT (Screening for Haemoglobinopathies In First Trimester) trial and other sources. Results: Compared tomidwife care, primary care sequential had a higher NHS cost of £34 000 per 10 000 pregnancies (95% confidence interval [CI] = £15 000 to £51 000) and an increase of 2623 women screened (95% CI: 1359 to 4495), giving a cost per additional woman screened by 10 weeks of £13. Primary care parallel was dominated by primary care sequential, with both higher costs and fewer women screened. Conclusion: The policy judgement is whether an earlier opportunity for informed reproductive choice has a value of at least £13. Further work is required to understand the value attached to earlier informed reproductive choices.

Original languageEnglish
Pages (from-to)e620-e627
Number of pages8
JournalBritish Journal of General Practice
Volume61
Issue number591
DOIs
Publication statusPublished - 2011
Externally publishedYes

Keywords

  • antenatal diagnosis
  • cost effectiveness
  • hemoglobin S disease
  • primary care
  • thalassemia
  • NHS Sickle Cell and Thalassaemia Screening Programme
  • SHIFT (Screening for Haemoglobinopathies In the First Trimester) trial

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    Bryan, S., Dormandy, E., Roberts, T., Ades, A., Barton, P., Juárez-García, A., Andronis, L., Karnon, J., & Marteau, T. M. (2011). Screening for sickle cell and thalassaemia in primary care: A cost-effectiveness study. British Journal of General Practice, 61(591), e620-e627. https://doi.org/10.3399/bjgp11X601325