COST-BENEFIT-ANALYSIS OF A NATIONAL SCREENING-PROGRAM FOR CYSTIC-FIBROSIS IN AN ISRAELI POPULATION

The recently acquired ability to identify 97% of CF carriers in an Isr aeli Ashkenazi population, prompts an evaluation of a nationwide scree ning programme. In 1993, the programme would first screen and counsel 9,261 parents, then 396 spouses of carrier parents and finally screen 16.5 fetuses where both parents are carriers. Assuming 92% of screened parents choose abortion of fetus screened positive, 2.33 cases of CF will be prevented in 1993 at a direct cost of $781,000. The $326,000 d irect costs of preventing a CF case, exceed the lifetime excess direct costs per case of $297,000. However, benefits of screening also accru e to subsequent pregnancies, resulting in a direct benefit ($14.45 mil lion) to cost ($10.39 million) ratio of 1.39/1 for the period 1993-203 2. When benefits and costs resulting from mortality changes, work abse nces and transport costs are included, the benefit ($15.95 million) to cost ($13.88 million) ratio falls to 1.15/1. Benefit-cost ratios are lower for other ethnic groups in Israel, due to lower carrier rates an d lower mutation detection abilities. A CF screening programme will in crease the freedom of individuals choice, but should be carried out ca refully in order to minimize stigmatization and even discrimination ag ainst CF carriers.