Universal versus targeted screening of infants for sickle cell disease: A cost-effectiveness analysis

Objective: To compare the health outcomes, costs, and incremental-cost-effe ctiveness of universal neonatal screening for sickle cell disease (SCP) wit h screening targeted to African Americans. Study design: A cost-effectiveness analysis was done by using a Markov simu lation model that considered the costs and outcomes associated with the pre vention and treatment of sepsis in those with sickle cell anemia and sickle beta(0)-thalassemia. Three strategies were compared: (1) no screening, (2) targeted screening of African Americans, and (3) universal screening for S CD. Results: In the base case analysis, targeted screening of African Americans compared with no screening cost $6709 per additional year of life saved an d universal screening compared with targeted screening cost $30,760 per add itional year of life saved. In a sensitivity analysis, the cost per:additio nal year of life saved with universal screening compared with targeted scre ening was positively correlated with the delivery rate of targeted screenin g and was inversely related to the proportion of African Americans in the p opulation, Conclusions: Targeted screening of African American newborns for SCD compar ed with no screening is always cost-effective. Universal screening compared with targeted screening always identifies more infants with disease, preve nts more deaths, and is cost-effective given certain delivery rates for tar geted screening and proportions of African Americans in the population.