Authors' objectives:

The objectives were:

1. To review alternative options for antenatal and neonatal haemoglobinopathy screening programmes in the UK

2. To develop a decision model that compares the cost-effectiveness of universal testing and selective testing based on maternal ethnic status

3. To apply the decision model to estimates of local health district ethnic composition

4. To identify areas for further policy development and research

Authors' recommendations: Selective screening is cost-effective in comparison with no screening. Universal screening may be cost-effective in higher-prevalence districts, depending on the coverage of selective screening and economic willingness-to-pay criteria. On baseline assumptions, if coverage among ethnic minorities in selective screening was 5% lower than in universal screening, a universal antenatal strategy would be cost-effective at a fetal sickle cell disease prevalence above 5-12 per 10,000 antenatal population and a universal neonatal strategy would be cost-effective at a prevalence above 7-18 per 10,000. Based on the health districts pertaining in 1993, the model would imply that up to 15 out of 170 districts should consider universal antenatal and/or universal neonatal screening. However, if selective screening obtained a coverage only 1% lower than universal screening, the latter would be requiredin, at most, two districts. Equity considerations suggest that: all districts could justifiably consider adopting explicit selective or universal strategies for antenatal and neonatal screening local policy could be determined on the basis of the same economic and prevalence criteria, applied nationally minimum standards for coverage of screening could be adopted and coverage monitored routinelyprocedures for selection based on ethnicity could be standardised.

Authors' methods: Systematic review, Economic evaluation

Project Status: Completed

URL for project: http://www.hta.ac.uk/915

Year Published: 1999

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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