BMJ 1995;311:1460 (2 December)

Papers

Cost effectiveness of antenatal screening for cystic fibrosis

H S Cuckle, professor of reproductive epidemiology,a G A Richardson, research fellow,b T A Sheldon, director,c P Quirke, reader d

a Centre for Reproduction, Growth and Development, Research School of Medicine, University of Leeds, Leeds LS2 9LN, b Centre for Health Economics, University of York, York YO1 5DD, c NHS Centre for Reviews and Dissemination, University of York, York YO1 5DD, d Molecular Oncology, Centre for Cancer Research, University of Leeds, Leeds LS2 9JT

Correspondence to: Professor Cuckle.

Abstract

Objective: To estimate the cost effectiveness of different antenatal screening programmes for cystic fibrosis.
Setting: Antenatal clinics and general practices in the United Kingdom.
Design: Four components of the screening process were identified: information giving, DNA testing, genetic counselling, and prenatal diagnosis. The component costs were derived from the literature and from a pilot screening study in Yorkshire. The cost of a given screening programme was then obtained by summing the components according to the specific screening strategy adopted (sequential and couple), the proportion of carriers detected by the DNA test, and the uptake of screening. Baseline assumptions were made about the proportion with missing information on carrier status from previous pregnancies (20%), the proportion changing partners between pregnancies (20%), and the uptake of prenatal diagnosis (100%). Sensitivity analysis was performed by varying these assumptions.
Main outcome measure: Cost per affected pregnancy detected.
Results: Under the baseline assumptions sequential screening costs between pounds sterling40000 and pounds sterling90000 per affected pregnancy detected, depending on the carrier detection rate and uptake. Couple screening was more expensive, ranging from pounds sterling46000 to pounds sterling104000. From the sensitivity analysis a 10% change in the assumed proportion with missing information from a previous pregnancy alters the cost by pounds sterling4000; a 10% change in the proportion with new partners has a similar effect but only for couple screening; and cost will change directly in proportion to the uptake of prenatal diagnosis.
Conclusions: While economic analysis cannot determine screening policy, the paper provides the NHS with the information on cost effectiveness needed to inform decisions on the introduction of a screening service for cystic fibrosis.

Key messages

  • Key messages

  • Cost effectiveness is highly sensitive to the cost of the DNA test and the proportion of carriers it can detect

  • Couple screening is more expensive than a sequential testing strategy

  • The estimated lifetime costs of treatment are considerably greater than the costs of screening

  • Screening for this disorder is less cost effective than screening for Down's syndrome but not greatly so


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