A COMPARATIVE COST-ANALYSIS OF NEWBORN SCREENING FOR CLASSIC CONGENITAL ADRENAL-HYPERPLASIA IN TEXAS

Objective. Texas mandates a two-test newborn screening program for con genital adrenal hyperplasia (CAH): one test at birth and a second test at approximately one to two weeks after birth. The authors compared t he dollar cost of detecting infants with CAH clinically and through th e screening program. Methods. The authors estimated the costs of scree ning newborns in 1994 for CAH, including resources used by the Texas D epartment of Health and the broader cost to society. Results. Fifteen infants with classic CAH were diagnosed in Texas in 1994 among 325,521 infants born (1:21,701 cumulative incidence); Seven infants were dete cted clinically and the others were detected through screening, six on the first screen and two on the second screen. The first screen ident ified all previously undetected infants with severe salt-wasting CAH. The cumulative cost to diagnose the seven infants detected clinically was $79,187. The incremental costs for the screening program were $115 ,169 per additional infant diagnosed through the first screen and $242 ,865 per additional infant diagnosed through the second screen. Conclu sions. 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 d etect infants with the simple virilizing form of the disorder who may benefit from early treatment, the second screen is necessary, but it i s not as cost-effective as the first screen.