A comparative cost analysis of newborn screening for classic congenital adrenal hyperplasia in Texas

Objective. Texas mandates a two-test newborn screening program for congenit al adrenal hyperplasia (CAH): one test at birth and a second test at approx imately one to two weeks after birth, The authors compared the dollar cost of detecting infants with CAH clinically and through the screening program. Methods. The authors estimated the costs of screening newborns in 1994 for CAH, including resources used by the Texas Department of Health and the bro ader cost to society. Results, Fifteen infants with classic CAH were diagnosed in Texas in 1994 a mong 325,521 infants born (1:21,701 cumulative incidence). Seven infants we re detected clinically and the others were detected through screening, six on the first screen and two on the second screen. The first screen identifi ed all previously undetected infants with severe salt-wasting CAH, The cumu lative cost to diagnose the seven infants detected clinically was $79,187, The incremental costs for the screening program were $115,169 per additiona l infant diagnosed through the first screen and $242,865 per additional inf ant diagnosed through the second screen. Conclusions. if the goal is early diagnosis of infants with the severe salt -wasting form of CAH, a single screen is effective. If the goal is to detec t infants with the simple virilizing form of the disorder who may benefit f rom early treatment, the second screen is necessary, but it is not as cost- effective as the first screen.