COST-EFFECTIVENESS OF ANTENATAL SCREENING FOR CYSTIC-FIBROSIS

Objective-To estimate the cost effectiveness of different antenatal sc reening programmes for cystic fibrosis. Setting-Antenatal clinics and general practices in the United Kingdom. Design-Four components of the screening process were identified: information giving, DNA testing, g enetic counselling, and prenatal diagnosis. The component costs were d erived from the literature and from a pilot screening study in Yorkshi re. The cost of a given screening programme was then obtained by summi ng the components according to the specific screening strategy adopted (sequential and couple), the proportion of carriers detected by the D NA test, and the uptake of screening. Baseline assumptions were made a bout the proportion with missing information on carrier status from pr evious pregnancies (20%), the proportion changing partners between pre gnancies (20%), and the uptake of prenatal diagnosis (100%). Sensitivi ty analysis was performed by varying these assumptions. Main outcome m easure-Cost per affected pregnancy detected. Results-Under the baselin e assumptions sequential screening costs between pound 40000 and pound 90000 per affected pregnancy detected, depending on the carrier detec tion rate and uptake. Couple screening was more expensive, ranging fro m pound 46000 to pound 104000. From the sensitivity analysis a 10% cha nge in the assumed proportion with missing information from a previous pregnancy alters the cost by pound 4000; a 10%, change in the proport ion with new partners has a similar effect but only for couple screeni ng; and cost will change directly in proportion to the uptake of prena tal diagnosis. Conclusions-While economic analysis cannot determine sc reening policy, the paper provides the NHS with the information on cos t effectiveness needed to inform decisions on the introduction of a sc reening service for cystic fibrosis.