An analysis of relative costs and potential benefits of different policiesfor antenatal screening for beta thalassaemia trait and variant haemoglobins

Aims-To investigate the costs and potential benefits of different policies for antenatal screening for haemoglobinopathies in two multiethnic London c ommunities. Methods-1000 consecutive antenatal patient samples referred to each of two London teaching hospital laboratories for haemoglobinopathy testing were in vestigated using the standard procedures of the laboratory in question. Whe n the standard procedures did not include high performance liquid chromatog raphy (HPLC), this technique was added, in order to assess its diagnostic v alue and cost-effectiveness. A comparison was made between the costs and po tential benefits of universal testing for variant haemoglobins and beta tha lassaemia trait using HPLC and the costs and potential benefits of universa l testing for variant haemoglobins and selective testing for beta thalassae mia trait using the mean cell haemoglobin (MCH) as a screening test and les s automated techniques than HPLC for definitive diagnosis. Results-The costs of the two policies were found to be comparable, as the h igher reagent/instrument costs of HPLC were offset by the lower labour cost s. Universal testing of 2000 consecutive samples did not disclose any extra cases of beta thalassaemia trait which would not have been detected by uni versal screening and selective testing. However, six patients were found to have a haemoglobin A2 variant which can interfere with the diagnosis of be ta thalassaemia trait. Conclusions-The introduction of universal testing by HPLC into British labo ratories could be cost neutral and has potential benefits. If a higher cost is accepted then the greater degree of automation could be used to release skilled staff for other tasks within the laboratory.