Candidate for the Lee B. Lusted Student Prize Competition
Purpose: Studies have demonstrated that earlier detection of infants with Severe Combined Immunodeficiency (SCID) improves survival and many have suggested that universal neonatal screening for SCID would significantly improve outcomes for those children affected. This study investigates the cost-effectiveness of universal screening, taking into account the costs and benefits associated with early detection of SCID.
Methods: A decision analytic model was built using TreeAge software that compared universal newborn screening vs. no screening for SCID. All costs and benefits were derived from available literature. Utilities ranging from 0 (death) to 1 (perfect health) were applied to discounted life expectancy at a rate of 3% to generate QALYs. Baseline values for the newborn screening test included sensitivity of 0.84, specificity of 0.97 and a cost of $5.50. The cost-effectiveness threshold was set to $100,000 per QALY. Base-case and one-way sensitivity analysis of model parameters were performed.
Results: Universal screening as compared to no screening for SCID is more expensive, more effective, and cost effective at $87,081 per QALY (Table 1). For the screening test, at a specificity less than 0.96, it’s no longer cost effective, however, sensitivity must be greater than 0.73 for universal screening to be cost effective. The model was quite sensitive to the cost of screening; at a cost of $8.50 per test universal was no longer cost effective.
Conclusions: At baseline, universal screening for SCID is marginally cost effective under our assumptions. The body of literature in this area suggests significant improvement in outcomes in those children with SCID who are identified at birth with a 50.4% reduction in overall mortality. The costs of screening and diagnosis of SCID need additional investigation to clarify whether this cost-effectiveness ratio can be further reduced.
| Table 1. Outcomes of Universal Newborn Screening for SCID
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| Universal Screening | No Screening | Differences |
Per 4 million live births |
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Costs | $81,129,000 | $6,320,000 | $74,809,000 |
QALYs | 107,097,232 | 107,096,376 | 856 |
ICER | $87,081/ QALY | ||
See more of: The 33rd Annual Meeting of the Society for Medical Decision Making