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 (pound 209); 2. cost of identifying at-risk fetus before confirmation by prenatal diagnosis (pound 2455); 3. cost of providing genetic information and counselling to mother with abnormal haemoglobin (pound 109); 3. programme savings from cases averted (pound 61,000). 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 (pound 1350) 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.