Screening for sickle cell and thalassaemia in primary care: A cost-effectiveness study

Abstract

Background: Haemoglobinopathies, including sickle cell disease and thalassaemia (SCT), are inherited disorders of haemoglobin. Antenatal screening for SCT rarely occurs before 10 weeks of pregnancy. Aim: To explore the cost-effectiveness of offering SCT screening in a primary care setting, during the pregnancy confirmation visit. Design and setting: A model-based cost-effectiveness analysis of inner-city areas with a high proportion of residents from ethnic minority groups. Method: Comparison was made of three SCT screening approaches: `primary care parallel' (primary care screening with test offered to mother and father together); `primary care sequential (primary care screening with test offered to the mother and then the father only if the mother is a carrier); and `midwife care' (sequential screening at the first midwife consultation). The model was populated with data from the SHIFT (Screening for Haemoglobinopathies In First Trimester) trial and other sources. Results: Compared to midwife care, primary care sequential had a higher NHS cost of £34 000 per 10 000 pregnancies (95% confidence interval [CI] = £15 000 to £51 000) and an increase of 2623 women screened (95% CI: 1359 to 4495), giving a cost per additional woman screened by 10 weeks of £13. Primary care parallel was dominated by primary care sequential, with both higher costs and fewer women screened. Conclusion: The policy judgement is whether an earlier opportunity for informed reproductive choice has a value of at least £13. Further work is required to understand the value attached to earlier informed reproductive choices.