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Kaiser J. Sequencing projects will screen 200,000 newborns for disease. Science 2022; 378:1159. [PMID: 36520905 DOI: 10.1126/science.adg2858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
U.K. and New York City efforts face cost and ethical issues.
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Valcárcel Nazco C, García Pérez L, Linertová R, Castilla I, Vallejo Torres L, Ramos Goñi JM, Labrador Cañadas V, Couce ML, Espada Sáenz-Torres M, Dulín Íñiguez E, Posada M, Imaz Iglesia I, Serrano Aguilar P. [Cost-effectiveness methods of newborn screening assessment.]. Rev Esp Salud Publica 2021; 95:e202101009. [PMID: 33496278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023] Open
Abstract
Newborn screening programs are a fundamental tool for secondary prevention or pre-symptomatic detection of certain conditions. The implementation of a newborn screening program requires an evaluation of effectiveness, safety, cost-effectiveness, feasibility and budget impact. Economic evaluation aims to contribute to the sustainability and solvency of health systems, especially when it comes to informing about financing health interventions with public funds. This funding must be justified on the basis of robust evidence of effectiveness, safety, cost-effectiveness, and acceptability. One of the most important limitations when evaluating the cost-effectiveness of a newborn screening program for hereditary disorders or congenital errors of metabolism is the scarcity of scientific evidence that limits the robustness of the economic analysis. Given the low availability of data, the use of expert opinion as a data source is unavoidable to complete the information. However, two main problems make it difficult to synthesize data obtained from various sources: biases and heterogeneity. Moreover, the measurement of quality-adjusted life years (QALYs) in pediatric populations poses serious methodological challenges. In Spain, although there is some heterogeneity in the supply of newborn screening programs between regions, guidelines are being established based on the best available scientific evidence to achieve the homogenization of newborn screening policies and programs at national level.
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Affiliation(s)
- Cristina Valcárcel Nazco
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC). Islas Canarias. España
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Madrid. España
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS). Madrid. España
- Servicio de Evaluación de la Dirección del Servicio Canario de la Salud (SESCS). Santa Cruz de Tenerife. España
| | - Lidia García Pérez
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC). Islas Canarias. España
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Madrid. España
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS). Madrid. España
- Servicio de Evaluación de la Dirección del Servicio Canario de la Salud (SESCS). Santa Cruz de Tenerife. España
| | - Renata Linertová
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC). Islas Canarias. España
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Madrid. España
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS). Madrid. España
- Servicio de Evaluación de la Dirección del Servicio Canario de la Salud (SESCS). Santa Cruz de Tenerife. España
| | - Iván Castilla
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Madrid. España
- Departamento de Ingeniería Informática y de Sistemas. Universidad de La Laguna. Tenerife. España
| | - Laura Vallejo Torres
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Madrid. España
- Departamento de Métodos Cuantitativos en Economía y Gestión. Universidad de Las Palmas de Gran Canaria. Gran Canaria. España
| | - Juan Manuel Ramos Goñi
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC). Islas Canarias. España
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Madrid. España
| | | | - María Luz Couce
- Servicio de Neonatología. Unidad de Diagnóstico y tratamiento de Enfermedades Metabólicas Congénitas. Hospital Clínico Universitario de Santiago de Compostela. IDIS. CIBERER. España
| | | | - Elena Dulín Íñiguez
- Experta en cribado neonatal. Asesora de la Ponencia de cribado poblacional de la Dirección General de Salud Pública del Ministerio de Sanidad
| | - Manuel Posada
- Instituto de Investigación en Enfermedades Raras. Instituto de Salud Carlos III. Madrid. España
| | - Iñaki Imaz Iglesia
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Madrid. España
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS). Madrid. España
- Agencia de Evaluación de Tecnologías Sanitarias. Instituto de Salud Carlos III. Madrid. España
| | - Pedro Serrano Aguilar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Madrid. España
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS). Madrid. España
- Servicio de Evaluación de la Dirección del Servicio Canario de la Salud (SESCS). Santa Cruz de Tenerife. España
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Chen K, Zhong Y, Gu Y, Sharma R, Li M, Zhou J, Wu Y, Gao Y, Qin G. Estimated Cost-effectiveness of Newborn Screening for Congenital Cytomegalovirus Infection in China Using a Markov Model. JAMA Netw Open 2020; 3:e2023949. [PMID: 33275150 PMCID: PMC7718603 DOI: 10.1001/jamanetworkopen.2020.23949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Congenital cytomegalovirus infection (cCMVi) is one of the most common infections associated with childhood hearing loss. Prevention and mitigation of cCMVi-related hearing loss will require an increase in newborn screening, which is not yet available in China. OBJECTIVE To estimate the cost-effectiveness of newborn screening strategies for cCMVi from the perspective of the Chinese health care system. DESIGN, SETTING, AND PARTICIPANTS A decision tree for a simulated cohort population of 15 000 000 live births was developed to compare the costs and health effects of 3 mutually exclusive interventions: (1) no screening, (2) targeted screening using CMV polymerase chain reaction assay for newborns who fail a universal hearing screening, and (3) universal screening for CMV among all newborns. Markov diagrams were used to evaluate the lifetime horizon (76 years). MAIN OUTCOMES AND MEASURES Cost, hearing-related health outcomes, and incremental cost-effectiveness ratios (ICERs) were estimated based on a direct medical costs perspective. Costs and ICERs were reported in 2018 US dollars. RESULTS Incidence of cCMVi among newborns was reported to be approximately 0.7% in China. Targeted screening was less costly but also less effective than universal screening, identifying 41% of cases needing antiviral treatment and preventing nearly half of less severe or profound hearing loss. To avoid 1 CMV-related severe or profound hearing loss, 13 and 16 newborns need to be treated by targeted and universal screening, respectively. The ICERs of targeted and universal screening vs no screening were $79 and $2087 per quality-adjusted life-year gained, respectively, at the discounted rate of 3.5%. Both screening options were cost-effective for the Chinese health care system based on the willingness-to-pay threshold of 3 × gross domestic product per capita. The sensitivity analysis showed that the prevalence of cCMVi, as well as diagnosis and treatment costs, were key factors that may be associated with decision-making. CONCLUSIONS AND RELEVANCE To achieve cost-effectiveness and best health outcomes, universal screening could be considered for the Chinese population. While the results are specific to China, the model may easily be adapted for other countries.
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Affiliation(s)
- Kai Chen
- Department of Internal Medicine, Nantong University Medical School, Nantong, Jiangsu, China
| | - Yaqin Zhong
- Department of Health Management, Nantong University School of Public Health, Nantong, Jiangsu, China
| | - Yuanyuan Gu
- Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Rajan Sharma
- Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Muting Li
- Department of Health Management, Nantong University School of Public Health, Nantong, Jiangsu, China
| | - Jinjun Zhou
- Department of Pediatrics, Nantong Maternal and Child Health Hospital, Nantong University, Nantong, Jiangsu, China
| | - Youjia Wu
- Department of Pediatrics, Nantong University Affiliated Hospital, Nantong, Jiangsu, China
| | - Yuexia Gao
- Department of Health Management, Nantong University School of Public Health, Nantong, Jiangsu, China
| | - Gang Qin
- Department of Infectious Diseases, Nantong Third People’s Hospital Affiliated to Nantong University, Nantong, Jiangsu, China
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Mukerji A, Shafey A, Jain A, Cohen E, Shah PS, Sander B, Shah V. Pulse oximetry screening for critical congenital heart defects in Ontario, Canada: a cost-effectiveness analysis. Can J Public Health 2020; 111:804-811. [PMID: 31907759 PMCID: PMC7501328 DOI: 10.17269/s41997-019-00280-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 12/03/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Previously conducted cost-effectiveness analyses of pulse oximetry screening (POS) for critical congenital heart defects (CCHDs) have shown it to be a cost-effective endeavour, but the geographical setting of Ontario in relation to its vast yet sparsely populated regions presents unique challenges. The objective of this study was to estimate the cost-effectiveness of POS for CCHD in Ontario, Canada. METHODS A cost-effectiveness analysis, comparing POS to no POS, was conducted from the Ontario healthcare payer perspective using a Markov model. The base case was defined as a well-appearing newborn at 24 h of age. Outcome measures, including quality-adjusted life months (QALMs), lifetime costs, and incremental cost-effectiveness ratios (ICER) [ΔCost/ΔQALMs], were calculated over a lifetime horizon. All outcomes were discounted at 1.5% per year. Cost-effectiveness was assessed using an a priori ICER threshold of CAD$4166.67 per QALM (equivalent to CAD$50,000 per quality-adjusted life year). Deterministic and probabilistic sensitivity analyses were conducted to assess parameter uncertainty. RESULTS Implementation of POS is expected to lead to timely diagnosis of 51 CCHD cases annually. The incremental cost of performing POS was estimated to be $27.27 per screened individual, with a gain of 0.02455 QALMs. This yielded an ICER of CAD$1110.79 per QALM, well below the pre-determined threshold. The probabilistic sensitivity analysis estimated a 92.3% chance of routine implementation of POS being cost-effective. CONCLUSION Routine implementation of POS for CCHD in Ontario is expected to be cost-effective.
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Affiliation(s)
- Amit Mukerji
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Amy Shafey
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Amish Jain
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Vibhuti Shah
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Narayen IC, te Pas AB, Blom NA, van den Akker-van Marle ME. Cost-effectiveness analysis of pulse oximetry screening for critical congenital heart defects following homebirth and early discharge. Eur J Pediatr 2019; 178:97-103. [PMID: 30334077 PMCID: PMC6311198 DOI: 10.1007/s00431-018-3268-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/07/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022]
Abstract
Pulse oximetry (PO) screening is used to screen newborns for critical congenital heart defects (CCHD). Analyses performed in hospital settings suggest that PO screening is cost-effective. We assessed the costs and cost-effectiveness of PO screening in the Dutch perinatal care setting, with home births and early postnatal discharge, compared to a situation without PO screening. Data from a prospective accuracy study with 23,959 infants in the Netherlands were combined with a time and motion study and supplemented data. Costs and effects of the situations with and without PO screening were compared for a cohort of 100,000 newborns. Mean screening time per newborn was 4.9 min per measurement and 3.8 min for informing parents. The additional costs of screening were in total €14.71 per screened newborn (€11.00 personnel, €3.71 equipment costs). Total additional costs of screening and referral were €1,670,000 per 100,000 infants. This resulted in an incremental cost-effectiveness ratio of €139,000 per additional newborn with CCHD detected with PO, when compared to a situation without PO screening. A willingness-to-pay threshold of €20,000 per gained QALY for screening in the Netherlands makes the screening likely to be cost-effective.Conclusion: PO screening in the Dutch care setting is likely to be cost-effective. What is Known: • Pulse oximetry is increasingly implemented as a screening tool for critical congenital heart defects in newborns. • Previous studies suggest that the screening in cost-effective and in the USA a reduction in infant mortality from critical congenital heart defects was demonstrated. What is New: • This is the first cost-effectiveness analysis for pulse oximetry screening in a setting with screening after home births, with screening at two moments. • Costs of pulse oximetry screening in a setting with hospital and homebirth deliveries were €14.71 and is likely to be cost-effective accordint to Dutch standards.
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Affiliation(s)
- Ilona C. Narayen
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjan B. te Pas
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nico A. Blom
- Department of Pediatrics, Division of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - M. Elske van den Akker-van Marle
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
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Speiser PW, Arlt W, Auchus RJ, Baskin LS, Conway GS, Merke DP, Meyer-Bahlburg HFL, Miller WL, Murad MH, Oberfield SE, White PC. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2018; 103:4043-4088. [PMID: 30272171 PMCID: PMC6456929 DOI: 10.1210/jc.2018-01865] [Citation(s) in RCA: 505] [Impact Index Per Article: 84.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 01/29/2023]
Abstract
Objective To update the congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency clinical practice guideline published by the Endocrine Society in 2010. Conclusions The writing committee presents updated best practice guidelines for the clinical management of congenital adrenal hyperplasia based on published evidence and expert opinion with added considerations for patient safety, quality of life, cost, and utilization.
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Affiliation(s)
- Phyllis W Speiser
- Cohen Children’s Medical Center of New York, New York, New York
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Wiebke Arlt
- University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Deborah P Merke
- National Institutes of Health Clinical Center, Bethesda, Maryland
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Heino F L Meyer-Bahlburg
- New York State Psychiatric Institute, Vagelos College of Physicians & Surgeons of Columbia University, New York, New York
| | - Walter L Miller
- University of California San Francisco, San Francisco, California
| | - M Hassan Murad
- Mayo Clinic’s Evidence-Based Practice Center, Rochester, Minnesota
| | - Sharon E Oberfield
- NewYork–Presbyterian, Columbia University Medical Center, New York, New York
| | - Perrin C White
- University of Texas Southwestern Medical Center, Dallas, Texas
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Bessey A, Chilcott JB, Leaviss J, Sutton A. Economic impact of screening for X-linked Adrenoleukodystrophy within a newborn blood spot screening programme. Orphanet J Rare Dis 2018; 13:179. [PMID: 30309370 PMCID: PMC6182830 DOI: 10.1186/s13023-018-0921-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/24/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A decision tree model was built to estimate the economic impact of introducing screening for X-linked adrenoleukodystrophy (X-ALD) into an existing tandem mass spectrometry based newborn screening programme. The model was based upon the UK National Health Service (NHS) Newborn Blood Spot Screening Programme and a public service perspective was used with a lifetime horizon. The model structure and parameterisation were based upon literature reviews and expert clinical judgment. Outcomes included health, social care and education costs and quality adjusted life years (QALYs). The model assessed screening of boys only and evaluated the impact of improved outcomes from hematopoietic stem cell transplantation in patients with cerebral childhood X-ALD (CCALD). Threshold analyses were used to examine the potential impact of utility decrements for non-CCALD patients identified by screening. RESULTS It is estimated that screening 780,000 newborns annually will identify 18 (95%CI 12, 27) boys with X-ALD, of whom 10 (95% CI 6, 15) will develop CCALD. It is estimated that screening may detect 7 (95% CI 3, 12) children with other peroxisomal disorders who may also have arisen symptomatically. If results for girls are returned an additional 17 (95% CI 12, 25) cases of X-ALD will be identified. The programme is estimated to cost an additional £402,000 (95% CI £399-407,000) with savings in lifetime health, social care and education costs leading to an overall discounted cost saving of £3.04 (95% CI £5.69, £1.19) million per year. Patients with CCALD are estimated to gain 8.5 discounted QALYs each giving an overall programme benefit of 82 (95% CI 43, 139) QALYs. CONCLUSION Including screening of boys for X-ALD into an existing tandem mass spectrometry based newborn screening programme is projected to reduce lifetime costs and improve outcomes for those with CCALD. The potential disbenefit to those identified with non-CCALD conditions would need to be substantial in order to outweigh the benefit to those with CCALD. Further evidence is required on the potential QALY impact of early diagnosis both for non-CCALD X-ALD and other peroxisomal disorders. The favourable economic results are driven by estimated reductions in the social care and education costs.
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Affiliation(s)
- Alice Bessey
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - James B Chilcott
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Joanna Leaviss
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Anthea Sutton
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
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Pereira S, Clayton EW. Commercial Interests, the Technological Imperative, and Advocates: Three Forces Driving Genomic Sequencing in Newborns. Hastings Cent Rep 2018; 48 Suppl 2:S43-S44. [PMID: 30133724 DOI: 10.1002/hast.885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
While the NSIGHT program was driven by a desire to define and gather data about both the benefits and harms of introducing genomic sequencing into the care of newborns, it remains to be seen how much influence these data will have in shaping the use of this technology in newborns. Ultimately, three additional forces-commercial interests, the technological imperative, and advocates-may play a significant role in shaping the use of sequencing in newborns. Policy-makers and clinicians should be aware of the effects of these additional forces when considering the appropriate use of this technology in clinical practice and public health screening programs.
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Holm IA, Agrawal PB, Ceyhan-Birsoy O, Christensen KD, Fayer S, Frankel LA, Genetti CA, Krier JB, LaMay RC, Levy HL, McGuire AL, Parad RB, Park PJ, Pereira S, Rehm HL, Schwartz TS, Waisbren SE, Yu TW, Green RC, Beggs AH. The BabySeq project: implementing genomic sequencing in newborns. BMC Pediatr 2018; 18:225. [PMID: 29986673 PMCID: PMC6038274 DOI: 10.1186/s12887-018-1200-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 06/27/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The greatest opportunity for lifelong impact of genomic sequencing is during the newborn period. The "BabySeq Project" is a randomized trial that explores the medical, behavioral, and economic impacts of integrating genomic sequencing into the care of healthy and sick newborns. METHODS Families of newborns are enrolled from Boston Children's Hospital and Brigham and Women's Hospital nurseries, and half are randomized to receive genomic sequencing and a report that includes monogenic disease variants, recessive carrier variants for childhood onset or actionable disorders, and pharmacogenomic variants. All families participate in a disclosure session, which includes the return of results for those in the sequencing arm. Outcomes are collected through review of medical records and surveys of parents and health care providers and include the rationale for choice of genes and variants to report; what genomic data adds to the medical management of sick and healthy babies; and the medical, behavioral, and economic impacts of integrating genomic sequencing into the care of healthy and sick newborns. DISCUSSION The BabySeq Project will provide empirical data about the risks, benefits and costs of newborn genomic sequencing and will inform policy decisions related to universal genomic screening of newborns. TRIAL REGISTRATION The study is registered in ClinicalTrials.gov Identifier: NCT02422511 . Registration date: 10 April 2015.
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Affiliation(s)
- Ingrid A. Holm
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Pankaj B. Agrawal
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA USA
| | - Ozge Ceyhan-Birsoy
- Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, MA USA
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Kurt D. Christensen
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Shawn Fayer
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Leslie A. Frankel
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX USA
- Department of Psychological, Health and Learning Sciences, University of Houston College of Education, Houston, TX USA
| | - Casie A. Genetti
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA USA
| | - Joel B. Krier
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Rebecca C. LaMay
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Harvey L. Levy
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Amy L. McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX USA
| | - Richard B. Parad
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Peter J. Park
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA USA
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX USA
| | - Heidi L. Rehm
- Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, MA USA
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
- The Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Talia S. Schwartz
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA USA
| | - Susan E. Waisbren
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Timothy W. Yu
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
- The Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Robert C. Green
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- The Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Alan H. Beggs
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
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Abstract
BACKGROUND Babies at risk of neonatal hypoglycaemia are often screened using cot-side glucometers, but non-enzymatic glucometers are inaccurate, potentially resulting in over-treatment and under-treatment, and low values require laboratory confirmation. More accurate enzymatic glucometers are available but at apparently higher costs. OBJECTIVE Our objective was to compare the cost of screening for neonatal hypoglycaemia using point-of-care enzymatic and non-enzymatic glucometers. METHODS We used a decision tree to model costs, including consumables and staff time. Sensitivity analyses assessed the impact of staff time, staff costs, probability that low results are confirmed via laboratory testing, false-positive and false-negative rates of non-enzymatic glucometers, and the blood glucose concentration threshold. RESULTS In the primary analysis, screening using an enzymatic glucometer cost NZD 86.94 (USD 63.47) while using a non-enzymatic glucometer cost NZD 97.08 (USD 70.87) per baby. Sensitivity analyses showed that using an enzymatic glucometer is cost saving with wide variations in staff time and costs, irrespective of the false-positive level of non-enzymatic glucometers, and where ≥78% of low values are laboratory confirmed. Where non-enzymatic glucometers may be less costly (e.g., false-negative rate exceeds 15%), instances of hypoglycaemia will be missed. Reducing the blood glucose concentration threshold to 1.94 mmol/L reduced the incidence of hypoglycaemia from 52 to 13%, and the cost of screening using a non-enzymatic glucometer to NZD 47.71 (USD 34.83). CONCLUSIONS In view of their lower cost in most circumstances and greater accuracy, enzymatic glucometers should be routinely utilised for point-of-care screening for neonatal hypoglycaemia.
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Affiliation(s)
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Richard Edlin
- School of Population Health, University of Auckland, Auckland, New Zealand
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11
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Abstract
BACKGROUND Pulse oximetry screening is a highly accurate tool for the early detection of critical congenital heart disease (CCHD) in newborn infants. As the technique is simple, noninvasive, and inexpensive, it has potentially significant benefits for developing countries. The aim of this study is to provide information for future clinical and health policy decisions by assessing the cost-effectiveness of CCHD screening in China. METHODS AND FINDINGS We developed a cohort model to evaluate the cost-effectiveness of screening all Chinese newborns annually using 3 possible screening options compared to no intervention: pulse oximetry alone, clinical assessment alone, and pulse oximetry as an adjunct to clinical assessment. We calculated the incremental cost per averted disability-adjusted life years (DALYs) in 2015 international dollars to measure cost-effectiveness. One-way sensitivity analysis and multivariate probabilistic sensitivity analysis were performed to test the robustness of the model. Of the three screening options, we found that clinical assessment is the most cost-effective strategy compared to no intervention with an incremental cost-effectiveness ratio (ICER) of Int$5,728/DALY, while pulse oximetry plus clinical assessment with the highest ICER yielded the best health outcomes. Sensitivity analysis showed that when the treatment rate increased up to 57.5%, pulse oximetry plus clinical assessment showed the best expected values among the three screening options. CONCLUSION In China, for neonatal screening for CCHD at the national level, clinical assessment was a very cost-effective preliminary choice and pulse oximetry plus clinical assessment was worth considering for the long term. Improvement in accessibility to treatment is crucial to expand the potential health benefits of screening.
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Affiliation(s)
- Ruoyan Gai Tobe
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- School of Public Health, Shandong University, Jinan, China
| | - Gerard R. Martin
- The George Washington University School of Medicine and the Children's National Medical Center, Washington, DC
| | - Fuhai Li
- Qilu Hospital of Shandong University, Jinan, China
| | - Akinori Moriichi
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Bin Wu
- The Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital affiliated with the School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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Abstract
Objective: The primary aim of this analysis was to prospectively assess the full economic costs associated with implementing Newborn Hearing Screening Programme (NHSP) based on a two-stage screen, transient evoked otoacoustic emissions followed, if there is no clear response, by automated auditory brainstem response. Economic data were also collected from the Infant Distraction Test Screening (IDTS) service performed by health visitors at around eight months of age, which was being phased out. A comparison of costs and outcomes associated with NHSP and IDTS was conducted. Design: 20 NHSP sites were invited to provide detailed cost data on NHSP implementation and 14 of these sites were selected to provide costs on the IDTS service that was being supplanted. Results: There was marked variability in the costs. Given the higher yield of NHSP sites, the average cost per case detected across NHSP sites (£31,410/case) was approximately half that of IDTS sites (£69,919/case). Including family costs, the average total cost per case of NHSP (£34,826/case) was almost a quarter of IDTS (£117,942/case). Conclusions: Family costs and cost per case associated with NHSP are considerably less than that with IDTS. These findings support the policy of implementation of NHSP and the phasing out of the IDTS.
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Affiliation(s)
- K Uus
- Audiology & Deafness Group, School of Psychological Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
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Rastogi S. Is Newborn Hearing Screening Worthwhile in India? Indian Pediatr 2016; 53:441-442. [PMID: 27254069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Supriya Rastogi
- Division of Neonatology, Max Super Speciality Hospital, Shalimar Bagh, Delhi, India.
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14
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Paul AK. Is Newborn Hearing Screening Worthwhile in India?: Authors Reply. Indian Pediatr 2016; 53:442. [PMID: 27254070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Mak DYF, Sykes J, Stephenson AL, Lands LC. The benefits of newborn screening for cystic fibrosis: The Canadian experience. J Cyst Fibros 2016; 15:302-8. [PMID: 27118577 DOI: 10.1016/j.jcf.2016.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The impact of newborn screening (NBS) for cystic fibrosis (CF) on early indicators of long-term health was evaluated in the context of government-sponsored healthcare and access to current therapies. METHODS Using data from the Canadian CF Registry between 2008 and 2013, we compared the rates of respiratory infections and markers of nutritional status in those diagnosed through NBS to those who were diagnosed clinically within the same time period using Mann-Whitney and Fischer's exact test as appropriate. RESULTS The study included 303 subjects, 201 in the NBS group and 102 in the non-NBS group. NBS patients were diagnosed earlier and had their first clinic visit at a younger age. Pancreatic insufficiency was less common in NBS patients. The incidence of Pseudomonas aeruginosa and Staphylococcus aureus were lower in NBS patients. After adjusting for age at clinic visit, gender, pancreatic status, and Pseudomonas aeruginosa infection status, mean z-scores for weight-for-age and height-for-age were higher in NBS patients, with no differences in BMI-for-age. CONCLUSIONS NBS programs for CF lead to improved long-term health outcomes for the CF population.
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Affiliation(s)
- D Y F Mak
- Cystic Fibrosis Canada, 2323 Yonge Street Suite 800, Toronto, M4P 2C9, Canada.
| | - J Sykes
- Department of Respirology, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada.
| | - A L Stephenson
- Department of Respirology, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada.
| | - L C Lands
- Meakins-Christie Laboratories, Research Institute of McGill University Health Centre, Montreal, Canada; Montreal Children's Hospital-McGill University Health Centre, Respiratory Division, Montreal, Canada.
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16
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Lefterova MI, Shen P, Odegaard JI, Fung E, Chiang T, Peng G, Davis RW, Wang W, Kharrazi M, Schrijver I, Scharfe C. Next-Generation Molecular Testing of Newborn Dried Blood Spots for Cystic Fibrosis. J Mol Diagn 2016; 18:267-82. [PMID: 26847993 DOI: 10.1016/j.jmoldx.2015.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/21/2015] [Accepted: 11/19/2015] [Indexed: 12/19/2022] Open
Abstract
Newborn screening for cystic fibrosis enables early detection and management of this debilitating genetic disease. Implementing comprehensive CFTR analysis using Sanger sequencing as a component of confirmatory testing of all screen-positive newborns has remained impractical due to relatively lengthy turnaround times and high cost. Here, we describe CFseq, a highly sensitive, specific, rapid (<3 days), and cost-effective assay for comprehensive CFTR gene analysis from dried blood spots, the common newborn screening specimen. The unique design of CFseq integrates optimized dried blood spot sample processing, a novel multiplex amplification method from as little as 1 ng of genomic DNA, and multiplex next-generation sequencing of 96 samples in a single run to detect all relevant CFTR mutation types. Sequence data analysis utilizes publicly available software supplemented by an expert-curated compendium of >2000 CFTR variants. Validation studies across 190 dried blood spots demonstrated 100% sensitivity and a positive predictive value of 100% for single-nucleotide variants and insertions and deletions and complete concordance across the polymorphic poly-TG and consecutive poly-T tracts. Additionally, we accurately detected both a known exon 2,3 deletion and a previously undetected exon 22,23 deletion. CFseq is thus able to replace all existing CFTR molecular assays with a single robust, definitive assay at significant cost and time savings and could be adapted to high-throughput screening of other inherited conditions.
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Affiliation(s)
- Martina I Lefterova
- Department of Pathology, Stanford University Medical Center, Stanford, California
| | - Peidong Shen
- Stanford Genome Technology Center, Stanford University, Palo Alto, California
| | - Justin I Odegaard
- Department of Pathology, Stanford University Medical Center, Stanford, California
| | - Eula Fung
- Department of Pathology, Stanford University Medical Center, Stanford, California
| | - Tsoyu Chiang
- Department of Pathology, Stanford University Medical Center, Stanford, California
| | - Gang Peng
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ronald W Davis
- Stanford Genome Technology Center, Stanford University, Palo Alto, California
| | - Wenyi Wang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Martin Kharrazi
- California Department of Public Health, Environmental Health Investigations Branch, Richmond, California
| | - Iris Schrijver
- Department of Pathology, Stanford University Medical Center, Stanford, California; Department of Pediatrics, Stanford University Medical Center, Stanford, California
| | - Curt Scharfe
- Department of Pathology, Stanford University Medical Center, Stanford, California; Stanford Genome Technology Center, Stanford University, Palo Alto, California.
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Wright SJ, Jones C, Payne K, Dharni N, Ulph F. The Role of Information Provision in Economic Evaluations of Newborn Bloodspot Screening: A Systematic Review. Appl Health Econ Health Policy 2015; 13:615-26. [PMID: 25995075 PMCID: PMC4751163 DOI: 10.1007/s40258-015-0177-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND The extent to which economic evaluations have included the healthcare resource and outcome-related implications of information provision in national newborn bloodspot screening programmes (NBSPs) is not currently known. OBJECTIVES To identify if, and how, information provision has been incorporated into published economic evaluations of NBSPs. METHODS A systematic review of economic evaluations of NBSPs (up to November 2014) was conducted. Three electronic databases were searched (Ovid: Medline, Embase, CINAHL) using an electronic search strategy combining a published economic search filter with terms related to national NBSPs and screening-related technologies. These electronic searches were supplemented by searching the NHS Economic Evaluations Database (NHS EED) and hand-searching identified study reference lists. The results were tabulated and summarised as part of a narrative synthesis. RESULTS A total of 27 economic evaluations [screening-related technologies (n = 11) and NBSPs (n = 16)] were identified. The majority of economic evaluations did not quantify the impact of information provision in terms of healthcare costs or outcomes. Five studies did include an estimate of the time cost associated with information provision. Four studies included a value to reflect the disutility associated with parental anxiety caused by false-positive results, which was used as a proxy for the impact of imperfect information. CONCLUSION A limited evidence base currently quantifies the impact of information provision on the healthcare costs and impact on the users of NBSPs; the parents of newborns. We suggest that economic evaluations of expanded NBSPs need to take account of information provision otherwise the impact on healthcare costs and the outcomes for newborns and their parents may be underestimated.
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Affiliation(s)
- Stuart J Wright
- Manchester Centre for Health Economics, Institute of Population Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Cheryl Jones
- Manchester Centre for Health Economics, Institute of Population Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Institute of Population Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Nimarta Dharni
- Manchester Centre for Health Psychology, School of Psychological Sciences, The University of Manchester, Manchester, UK
| | - Fiona Ulph
- Manchester Centre for Health Psychology, School of Psychological Sciences, The University of Manchester, Manchester, UK
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Thiboonboon K, Leelahavarong P, Wattanasirichaigoon D, Vatanavicharn N, Wasant P, Shotelersuk V, Pangkanon S, Kuptanon C, Chaisomchit S, Teerawattananon Y. An Economic Evaluation of Neonatal Screening for Inborn Errors of Metabolism Using Tandem Mass Spectrometry in Thailand. PLoS One 2015; 10:e0134782. [PMID: 26258410 PMCID: PMC4530882 DOI: 10.1371/journal.pone.0134782] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/10/2015] [Indexed: 11/21/2022] Open
Abstract
Background Inborn errors of metabolism (IEM) are a rare group of genetic diseases which can lead to several serious long-term complications in newborns. In order to address these issues as early as possible, a process called tandem mass spectrometry (MS/MS) can be used as it allows for rapid and simultaneous detection of the diseases. This analysis was performed to determine whether newborn screening by MS/MS is cost-effective in Thailand. Method A cost-utility analysis comprising a decision-tree and Markov model was used to estimate the cost in Thai baht (THB) and health outcomes in life-years (LYs) and quality-adjusted life year (QALYs) presented as an incremental cost-effectiveness ratio (ICER). The results were also adjusted to international dollars (I$) using purchasing power parities (PPP) (1 I$ = 17.79 THB for the year 2013). The comparisons were between 1) an expanded neonatal screening programme using MS/MS screening for six prioritised diseases: phenylketonuria (PKU); isovaleric acidemia (IVA); methylmalonic acidemia (MMA); propionic acidemia (PA); maple syrup urine disease (MSUD); and multiple carboxylase deficiency (MCD); and 2) the current practice that is existing PKU screening. A comparison of the outcome and cost of treatment before and after clinical presentations were also analysed to illustrate the potential benefit of early treatment for affected children. A budget impact analysis was conducted to illustrate the cost of implementing the programme for 10 years. Results The ICER of neonatal screening using MS/MS amounted to 1,043,331 THB per QALY gained (58,647 I$ per QALY gained). The potential benefits of early detection compared with late detection yielded significant results for PKU, IVA, MSUD, and MCD patients. The budget impact analysis indicated that the implementation cost of the programme was expected at approximately 2,700 million THB (152 million I$) over 10 years. Conclusion At the current ceiling threshold, neonatal screening using MS/MS in the Thai context is not cost-effective. However, the treatment of patients who were detected early for PKU, IVA, MSUD, and MCD, are considered favourable. The budget impact analysis suggests that the implementation of the programme will incur considerable expenses under limited resources. A long-term epidemiological study on the incidence of IEM in Thailand is strongly recommended to ascertain the magnitude of problem.
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Affiliation(s)
- Kittiphong Thiboonboon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- * E-mail:
| | - Pattara Leelahavarong
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Duangrurdee Wattanasirichaigoon
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nithiwat Vatanavicharn
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pornswan Wasant
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suthipong Pangkanon
- Genetic Unit, Department of Pediatrics, The Queen Sirikit National Institute of Child Health, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
| | - Chulaluck Kuptanon
- Genetic Unit, Department of Pediatrics, The Queen Sirikit National Institute of Child Health, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
| | - Sumonta Chaisomchit
- Neonatal Screening Operation Centre, Department of Medical Science, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
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19
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Han Y, Huang L, Zhang W, Zhang Y, Jia X, Ni T, Sun H, Liang P, Yu H, Guo Y, Zhang A, Li J, Zhang H. [Cost-effectiveness of three-stage newborns hearing screening in Beijing]. Zhonghua Liu Xing Bing Xue Za Zhi 2015; 36:455-459. [PMID: 26080633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of two-stage and three-stage hearing screenings for newborns. METHODS Hearing screening was performed for the normal newborns born in 7 hospitals in Beijing from October 2010 to December 2012 by using two stage and three stage strategies as well as hearing diagnostic test, and the cost effectiveness evaluation of two strategies was conducted. The data about the cost of screening and diagnostic test were from the hospitals. The data about car fare and charge for loss of working time of parents were collected through questionnaire survey. The sensitivity was analyzed according to the compliance rate. RESULTS A total of 62,695 newborns received initial hearing screening, 5,809 newborns failed, the positive rate was 9.30%. A total of 4,933 newborns received rescreening, 972 newborns failed, the positive rate was 19.70%. Among the newborns failed in rescreening, 412 were provided with hearing diagnostic test and 360 received diagnostic test. The diagnostic test indicated that the hearing of 217 newborns were abnormal (60.28%). A total of 276 newborns received the third screening, 163 newborns failed, in which 125 received diagnostic test and 112 had abnormal hearing (45 had moderate and above hearing impairment), the abnormal rate was 89.60%. The average cost for three-stage screening (37,242 yuan RMB per case) was higher than that for two-stage screening (19,985 yuan RMB per case). With the increase of compliance, the cost-effectiveness of three-stage screening increased. CONCLUSION The cost-effectiveness of three-stage screening was influenced by screening compliance. It is recommended that three-stage screening strategy might be taken in area where the screening compliance rate is >90%.
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Affiliation(s)
- Youli Han
- School of Health Management and Education, Capital Medical University, Beijing 100069, China
| | - Lihui Huang
- Beijing Institute of Otorhinolaryngology, Beijing Tongren Hospital, Capital Medical University
| | - Wei Zhang
- Department of Neonate, Beijing Obstetrics Gynecology Hospital, Capital Medical University;
| | - Yanmei Zhang
- Beijing Institute of Otorhinolaryngology, Beijing Tongren Hospital, Capital Medical University
| | - Xiao Jia
- Department of Neonate, Beijing Obstetrics Gynecology Hospital, Capital Medical University
| | - Tingting Ni
- Beijing Institute of Otorhinolaryngology, Beijing Tongren Hospital, Capital Medical University
| | - Huihong Sun
- Department of Neonate, Beijing Obstetrics Gynecology Hospital, Capital Medical University
| | - Ping Liang
- Beijing Daxing Hospital of Maternal and Child Care
| | | | - Yan Guo
- Beijing Hospital of Chinese Traditional and Western Medicine
| | - Ai Zhang
- Beijing Fengtai Hospital of Maternal and Child Care
| | - Jiahui Li
- Beijing Shunyi Hospital of Traditional Chinese Medicine
| | - Hua Zhang
- Beijing Shunyi Hospital of Maternal and Child Care
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Heather NL, Seneviratne SN, Webster D, Derraik JGB, Jefferies C, Carll J, Jiang Y, Cutfield WS, Hofman PL. Newborn screening for congenital adrenal hyperplasia in New Zealand, 1994-2013. J Clin Endocrinol Metab 2015; 100:1002-8. [PMID: 25494862 DOI: 10.1210/jc.2014-3168] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the efficacy of national newborn screening for severe congenital adrenal hyperplasia (CAH) in New Zealand over the past 20 years. METHODS Newborn screening for CAH is performed through the estimation of 17-hydroxyprogesterone by a Delfia immunoassay. CAH cases diagnosed in the newborn period from 1994 to 2013 were identified from Newborn Metabolic Screening Programme records. RESULTS Between 1994 and 2013, 44 neonates (28 females, 16 males) were diagnosed with CAH, giving an incidence of 1:26 727. Almost half (n = 21) of the newborns with CAH were detected solely via screening (not clinically suspected), including 21% of all affected females. Among the group solely ascertained by screening, 17-hydroxyprogesterone sampling occurred at a mean age of 3.3 days (range 2-8 d), the duration from sampling to notification was 5.2 days (0-12 d), and treatment was initiated at 12.0 days (6-122 d). Vomiting was present in 14% of those ascertained by screening, but none had hypotension or collapse at diagnosis. Increasing age at treatment was correlated with a progressive decrease in serum sodium (r = -0.56; P < .0001) and an increase in serum potassium concentrations (r = 0.38; P = .017). Compared with newborns diagnosed by screening alone, those clinically diagnosed were predominantly female (96% vs 29%; P < .0001), notification occurred earlier (4.8 vs 8.5 d; P = .002), and had higher serum sodium (136.8 vs 130.8 mmol/L; P < .0001) and lower serum potassium (5.3 vs 6.0 mmol/L; P = .011) concentrations. CONCLUSIONS Screening alone accounted for nearly 50% cases of CAH detected in the newborn period, including a fifth of affected females, indicating that clinical diagnosis is unreliable in both genders. Symptoms were mild at diagnosis and there were no adrenal crises. This study confirms the benefits of newborn CAH screening.
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Affiliation(s)
- Natasha L Heather
- Starship Children's Hospital (N.L.H., C.J.), 1023 Auckland, New Zealand; Liggins Institute (S.N.S., J.G.B.D., W.S.C., P.L.H.) and Department of Statistics (Y.J.), University of Auckland, 1142 Auckland, New Zealand; and New Zealand National Screening Unit (D.W., J.C.), Ministry of Health, 1051 Auckland, New Zealand
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21
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Chays A. [For newborn hearing screening]. Rev Prat 2014; 64:1192-1193. [PMID: 25638850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Kubiak C, Jyonouchi S, Kuo C, Garcia-Lloret M, Dorsey MJ, Sleasman J, Zbrozek AS, Perez EE. Fiscal implications of newborn screening in the diagnosis of severe combined immunodeficiency. J Allergy Clin Immunol Pract 2014; 2:697-702. [PMID: 25439359 PMCID: PMC5911282 DOI: 10.1016/j.jaip.2014.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 03/25/2014] [Accepted: 05/06/2014] [Indexed: 12/31/2022]
Abstract
In the United States, newborn screening (NBS) is currently recommended for identification of 31 debilitating and potentially fatal conditions. However, individual states determine which of the recommended conditions are screened. The addition of severe combined immunodeficiency (SCID) screening to the recommended NBS panel has been fully instituted by 18 states, with another 11 states piloting programs or planning to begin screening in 2014. Untreated, SCID is uniformly fatal by 2 years of age. Hematopoietic stem cell transplantation usually is curative, but the success rate depends on the age at which the procedure is performed. Short-term implementation costs may be a barrier to adding SCID to states' NBS panels. A retrospective economic analysis was performed to determine the cost-effectiveness of NBS for early (<3.5 months) versus late (≥3.5 months) treatment of children with SCID at 3 centers over 5 years. The mean total charges at these centers for late treatment were 4 times greater than early treatment ($1.43 million vs $365,785, respectively). Mean charges for intensive care treatments were >5 times higher ($350,252 vs $66,379), and operating room-anesthesia charges were approximately 4 times higher ($57,105 vs $15,885). The cost-effectiveness of early treatment for SCID provides a strong economic rationale for the addition of SCID screening to NBS programs of other states.
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Affiliation(s)
- Catherine Kubiak
- Department of Pediatrics, Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Soma Jyonouchi
- Department of Pediatrics, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Caroline Kuo
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Maria Garcia-Lloret
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Morna J Dorsey
- Department of Pediatrics, Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - John Sleasman
- Department of Pediatrics, Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | | | - Elena E Perez
- Department of Pediatrics, Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, Tampa, Fla.
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Groselj U, Tansek MZ, Smon A, Angelkova N, Anton D, Baric I, Djordjevic M, Grimci L, Ivanova M, Kadam A, Kotori VM, Maksic H, Marginean O, Margineanu O, Milijanovic O, Moldovanu F, Muresan M, Murko S, Nanu M, Lampret BR, Samardzic M, Sarnavka V, Savov A, Stojiljkovic M, Suzic B, Tincheva R, Tahirovic H, Toromanovic A, Usurelu N, Battelino T. Newborn screening in southeastern Europe. Mol Genet Metab 2014; 113:42-5. [PMID: 25174966 DOI: 10.1016/j.ymgme.2014.07.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 07/21/2014] [Accepted: 07/22/2014] [Indexed: 11/20/2022]
Abstract
The aim of our study was to assess the current state of newborn screening (NBS) in the region of southeastern Europe, as an example of a developing region, focusing also on future plans. Responses were obtained from 11 countries. Phenylketonuria screening was not introduced in four of 11 countries, while congenital hypothyroidism screening was not introduced in three of them; extended NBS programs were non-existent. The primary challenges were identified. Implementation of NBS to developing countries worldwide should be considered as a priority.
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Affiliation(s)
- Urh Groselj
- University Children's Hospital Ljubljana, UMC Ljubljana, Ljubljana, Slovenia
| | - Mojca Zerjav Tansek
- University Children's Hospital Ljubljana, UMC Ljubljana, Ljubljana, Slovenia
| | - Andraz Smon
- University Children's Hospital Ljubljana, UMC Ljubljana, Ljubljana, Slovenia
| | | | - Dana Anton
- Clinical Hospital for Children "Sfanta Maria", Iasi, Romania
| | - Ivo Baric
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia; University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Maja Djordjevic
- Mother and Child Health Care Institute of Serbia, Belgrade, Serbia
| | - Lindita Grimci
- University Hospital Center "Mother Teresa", Tirana, Albania
| | | | - Adil Kadam
- University Pediatric Hospital Sofia, Sofia, Bulgaria
| | | | - Hajrija Maksic
- University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | | | - Olivera Milijanovic
- Institute for Sick Children, Clinical Center of Montenegro, Podgorica, Montenegro
| | | | - Mariana Muresan
- Clinical Hospital for Children "Iuliu Hateganu", Cluj-Napoca, Romania
| | - Simona Murko
- University Children's Hospital Ljubljana, UMC Ljubljana, Ljubljana, Slovenia
| | - Michaela Nanu
- Mother and Child Health Care Institute "Alfred Rusescu", Bucharest, Romania
| | | | - Mira Samardzic
- Institute for Sick Children, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Vladimir Sarnavka
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
| | | | - Maja Stojiljkovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Biljana Suzic
- Children Hospital Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | | | - Husref Tahirovic
- Department of Medical Sciences, Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Alma Toromanovic
- Department of Pediatrics, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Natalia Usurelu
- Institute of Mother and Child, Centre of Reproductive Health and Medical Genetics, Chisinau, Republic of Moldova
| | - Tadej Battelino
- University Children's Hospital Ljubljana, UMC Ljubljana, Ljubljana, Slovenia; Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Abstract
Newborn screening programmes began in the 1960s, have traditionally been conducted without parental permission and have grown dramatically in the last decade. Whether these programmes serve patients' best interests has recently become a point of controversy. Privacy advocates, concerned that newborn screening infringes upon individual liberties, are demanding fundamental changes to these programmes. These include parental permission and limiting the research on the blood samples obtained, an agenda at odds with the viewpoints of newborn screening advocates. This essay presents the history of newborn screening in the USA, with attention to factors that have contributed to concerns about these programmes. The essay suggests that the rapid increase in the number of disorders screened for and the addition of research without either public knowledge or informed consent were critical to the development of resistance to mandatory newborn screening and research. Future newborn screening initiatives should include public education and comment to ensure continued support.
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Zin AA, Magluta C, Pinto MFT, Entringer AP, Mendes-Gomes MA, Moreira MEL, Gilbert C. Retinopathy of prematurity screening and treatment cost in Brazil. Rev Panam Salud Publica 2014; 36:37-43. [PMID: 25211676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To assess the additional cost of incorporating the detection and treatment of retinopathy of prematurity (ROP) into neonatal care services of Brazil's Unified Health System (SUS). METHODS A deterministic decision-tree simulation model was built to estimate the direct costs of screening for and treating ROP in neonatal intensive-care units (NICUs), based on data for 869 preterm infants with birth weight less than 1 500 g examined in six governmental NICUs in the capital city of Rio de Janeiro, where coverage was 52% and 8% of infants were treated. All of the parameters from this study were extrapolated to Brazilian newborn estimates in 2010. Costs of screening and treatment were estimated considering staff, equipment and maintenance, and training based on published data and expert opinion. A budget impact analysis was performed considering the population of preterm newborns, screening coverage, and the incidence of treatable ROP. One- and two-way sensitivity analyses were performed. RESULTS In Rio de Janeiro, unit costs per newborn were US$ 18 for each examination, US$ 398 per treatment, and US$ 29 for training. The estimated cost of ROP diagnosis and treatment for all at-risk infants NICUs was US$ 80 per infant. The additional cost to the SUS for one year would be US$ 556 640 for a ROP program with 52% coverage, increasing to US$ 856 320 for 80% coverage, and US$ 1.07 million or 100% coverage. CONCLUSIONS The results of this study indicate that providing ROP care is affordable within the framework of the SUS in Brazil, and might be feasible elsewhere in Latin America, considering the evidence of the effectiveness of ROP treatment and the social benefits achieved.
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Affiliation(s)
- Andrea A Zin
- Department of Clinical Research, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil,
| | - Cynthia Magluta
- Department of Clinical Research, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil,
| | - Márcia F T Pinto
- Department of Clinical Research, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil,
| | - Aline P Entringer
- Department of Clinical Research, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil,
| | - Maria A Mendes-Gomes
- Department of Clinical Research, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil,
| | - Maria E L Moreira
- Department of Clinical Research, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil,
| | - Clare Gilbert
- London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, United Kingdom
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Fischer KE, Rogowski WH. Funding decisions for newborn screening: a comparative review of 22 decision processes in Europe. Int J Environ Res Public Health 2014; 11:5403-30. [PMID: 24852389 PMCID: PMC4053875 DOI: 10.3390/ijerph110505403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/29/2014] [Accepted: 05/09/2014] [Indexed: 11/30/2022]
Abstract
Decision-makers need to make choices to improve public health. Population-based newborn screening (NBS) is considered as one strategy to prevent adverse health outcomes and address rare disease patients' needs. The aim of this study was to describe key characteristics of decisions for funding new NBS programmes in Europe. We analysed past decisions using a conceptual framework. It incorporates indicators that capture the steps of decision processes by health care payers. Based on an internet survey, we compared 22 decisions for which answers among two respondents were validated for each observation. The frequencies of indicators were calculated to elicit key characteristics. All decisions resulted in positive, mostly unrestricted funding. Stakeholder participation was diverse focusing on information provision or voting. Often, decisions were not fully transparent. Assessment of NBS technologies concentrated on expert opinion, literature review and rough cost estimates. Most important appraisal criteria were effectiveness (i.e., health gain from testing for the children being screened), disease severity and availability of treatments. Some common and diverging key characteristics were identified. Although no evidence of explicit healthcare rationing was found, processes may be improved in respect of transparency and scientific rigour of assessment.
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Affiliation(s)
| | - Wolf Henning Rogowski
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany.
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Tiwana SK. Cost-effectiveness of expanded newborn screening in Texas-author response to letter to the editor. Value Health 2013; 16:1105. [PMID: 24041363 DOI: 10.1016/j.jval.2013.08.1903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/02/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Simrandeep K Tiwana
- Health Technology Assessment Unit, University of Calgary, Community Health Sciences, Calgary, AB, Canada
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Hsu CF, Kang KT, Leo Lee Y, Chie WC. Cost-effectiveness of expanded newborn screening in Texas. Value Health 2013; 16:1103-1104. [PMID: 24041362 DOI: 10.1016/j.jval.2013.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 06/16/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Ching-Fen Hsu
- Department of Family Medicine, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taipei, Taiwan, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
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Abstract
OBJECTIVES Clinical evidence indicates newborn critical congenital heart disease (CCHD) screening through pulse oximetry is lifesaving. In 2011, CCHD was added to the US Recommended Uniform Screening Panel for newborns. Several states have implemented or are considering screening mandates. This study aimed to estimate the cost-effectiveness of routine screening among US newborns unsuspected of having CCHD. METHODS We developed a cohort model with a time horizon of infancy to estimate the inpatient medical costs and health benefits of CCHD screening. Model inputs were derived from new estimates of hospital screening costs and inpatient care for infants with late-detected CCHD, defined as no diagnosis at the birth hospital. We estimated the number of newborns with CCHD detected at birth hospitals and life-years saved with routine screening compared with no screening. RESULTS Screening was estimated to incur an additional cost of $6.28 per newborn, with incremental costs of $20 862 per newborn with CCHD detected at birth hospitals and $40 385 per life-year gained (2011 US dollars). We estimated 1189 more newborns with CCHD would be identified at birth hospitals and 20 infant deaths averted annually with screening. Another 1975 false-positive results not associated with CCHD were estimated to occur, although these results had a minimal impact on total estimated costs. CONCLUSIONS This study provides the first US cost-effectiveness analysis of CCHD screening in the United States could be reasonably cost-effective. We anticipate data from states that have recently approved or initiated CCHD screening will become available over the next few years to refine these projections.
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Affiliation(s)
- Cora Peterson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Ramjattan K, Allen PJ. Pulse oximetry screening for critical congenital heart disease in the newborn. Pediatr Nurs 2013; 39:250-256. [PMID: 24308092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Kimberley Ramjattan
- Department of Physical Medicine and Rehabilitation, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Bakhireva LN, Savich RD, Raisch DW, Cano S, Annett RD, Leeman L, Garg M, Goff C, Savage DD. The feasibility and cost of neonatal screening for prenatal alcohol exposure by measuring phosphatidylethanol in dried blood spots. Alcohol Clin Exp Res 2013; 37:1008-15. [PMID: 23421919 PMCID: PMC3661684 DOI: 10.1111/acer.12045] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 10/30/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accurate confirmation of prenatal alcohol exposure (PAE) is required as a diagnostic criterion for the majority of children adversely affected by PAE who do not manifest the physical features associated with fetal alcohol syndrome. A number of ethanol biomarkers have been used to assess PAE, often with suboptimal results. The purpose of this study was to evaluate the feasibility and cost of PAE screening in newborns by measuring phosphatidylethanol (PEth) in dried blood spot (DBS) cards. METHODS The feasibility of collecting an additional DBS card during routine newborn screening and the background prevalence of PAE were evaluated in a de-identified sample of newborn children delivered at the University of New Mexico Hospital. Electronic orders to collect DBS cards from newborns who continue to bleed after the routine newborn screen, glucose, or hematocrit testing were initiated for all infants delivered during a 4-week time frame. Specimens were sent to a contract laboratory for PEth analysis by liquid chromatography-tandem mass spectrometry. A cost analysis was conducted to compare the cost of PAE screening by PEth in DBS versus PEth in conventional blood specimens and by meconium fatty acid ethyl esters. RESULTS From 230 collected cards, 201 (87.4%) had at least 1 full blood spot (amount sufficient for PEth analysis), and 6.5% had PEth >20 ng/ml indicative of potential PAE in late pregnancy. PAE screening by PEth in DBS is logistically simpler and less expensive compared with 2 other screening approaches. CONCLUSIONS These results indicate that screening for PAE in DBS cards is a feasible procedure and that a majority of infants have enough blood after the routine heel prick to fill an additional card. Moreover, screening by PEth analysis from DBS cards is cost-efficient. The acceptability of such screening by parents and corresponding ethical issues remain to be investigated.
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Affiliation(s)
- Ludmila N Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
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Abstract
Current ROP screening guidelines represent a simple risk model with two dichotomized factors, birth weight and gestational age at birth. Pioneering work has shown that tracking postnatal weight gain, a surrogate for low insulin-like growth factor 1, may capture the influence of many other ROP risk factors and improve risk prediction. Models including weight gain, such as WINROP, ROPScore, and CHOP ROP, have demonstrated accurate ROP risk assessment and a potentially large reduction in ROP examinations, compared to current guidelines. However, there is a need for larger studies, and generalizability is limited in countries with developing neonatal care systems.
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Affiliation(s)
- Gil Binenbaum
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Affiliation(s)
- James P Evans
- Department of Genetics, University of North Carolina at Chapel Hill, NC, USA.
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Tobe RG, Mori R, Huang L, Xu L, Han D, Shibuya K. Cost-effectiveness analysis of a national neonatal hearing screening program in China: conditions for the scale-up. PLoS One 2013; 8:e51990. [PMID: 23341887 PMCID: PMC3547019 DOI: 10.1371/journal.pone.0051990] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 11/13/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2009, the Chinese Ministry of Health recommended scale-up of routine neonatal hearing screening - previously performed primarily only in select urban hospitals - throughout the entire country. METHODS A decision analytical model for a simulated population of all live births in china was developed to compare the costs and health effects of five mutually exclusive interventions: 1) universal screening using Otoacoustic Emission (OAE) and Automated Auditory Brainstem Response (AABR); 2) universal OAE; 3) targeted OAE and AABR; 4) targeted OAE; and 5) no screening. Disability-Adjusted Life Years (DALYs) were calculated for health effects. RESULTS AND DISCUSSION Based on the cost-effectiveness and potential health outcomes, the optimal path for scale-up would be to start with targeted OAE and then expand to universal OAE and universal OAE plus AABR. Accessibility of screening, diagnosis, and intervention services significantly affect decision of the options. CONCLUSION In conclusion, to achieve cost-effectiveness and best health outcomes of the NHS program, the accessibility of screening, diagnosis, and intervention services should be expanded to reach a larger population. The results are thus expected to be of particular benefit in terms of the 'rolling out' of the national plan.
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Affiliation(s)
- Ruoyan Gai Tobe
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Lihui Huang
- Beijing Tongren Hospital, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Lingzhong Xu
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Demin Han
- Beijing Tongren Hospital, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, China
- China WHO Collaborating Center for the Prevention and Rehabilitation of Hearing Impairment, Beijing, China
- * E-mail:
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Rueschhoff A. Newborn health screenings. NCSL Legisbrief 2012; 20:1-2. [PMID: 23460998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
The frequency of premature births is increasing world-wide. This factor, combined with improved survival and revised screening criteria, is resulting in an increased workload in screening for retinopathy of prematurity. Digital retinal imaging is emerging as an important alternative tool for diagnosing retinopathy of prematurity, and its use has even been extended to developing countries. Neonatal nurses and technicians can be trained to use digital imaging devices effectively. This is important in areas that do not have ready access to paediatric ophthalmologists. The ability to transfer images electronically makes it a valuable tool in telemedicine, while the ability to store and retrieve images is also advantageous from a medico-legal perspective. Image analysis software can further improve the accuracy of diagnosis. The main limitation of this technology is its high capital cost.
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Langer A, Holle R, John J. Specific guidelines for assessing and improving the methodological quality of economic evaluations of newborn screening. BMC Health Serv Res 2012; 12:300. [PMID: 22947299 PMCID: PMC3459803 DOI: 10.1186/1472-6963-12-300] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 08/27/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Economic evaluation of newborn screening poses specific methodological challenges. Amongst others, these challenges refer to the use of quality adjusted life years (QALYs) in newborns, and which costs and outcomes need to be considered in a full evaluation of newborn screening programmes. Because of the increasing scale and scope of such programmes, a better understanding of the methods of high-quality economic evaluations may be crucial for both producers/authors and consumers/reviewers of newborn screening-related economic evaluations. The aim of this study was therefore to develop specific guidelines designed to assess and improve the methodological quality of economic evaluations in newborn screening. METHODS To develop the guidelines, existing guidelines for assessing the quality of economic evaluations were identified through a literature search, and were reviewed and consolidated using a deductive iterative approach. In a subsequent test phase, these guidelines were applied to various economic evaluations which acted as case studies. RESULTS The guidelines for assessing and improving the methodological quality of economic evaluations in newborn screening are organized into 11 categories: "bibliographic details", "study question and design", "modelling", "health outcomes", "costs", "discounting", "presentation of results", "sensitivity analyses", "discussion", "conclusions", and "commentary". CONCLUSIONS The application of the guidelines highlights important issues regarding newborn screening-related economic evaluations, and underscores the need for such issues to be afforded greater consideration in future economic evaluations. The variety in methodological quality detected by this study reveals the need for specific guidelines on the appropriate methods for conducting sound economic evaluations in newborn screening.
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Affiliation(s)
- Astrid Langer
- Institute of Health Economics and Health Care Management, Munich School of Management, Ludwig-Maximilians Universität München, Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München – German Research Centre for Environmental Health, Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München – German Research Centre for Environmental Health, Neuherberg, Germany
| | - Jürgen John
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München – German Research Centre for Environmental Health, Neuherberg, Germany
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Abstract
OBJECTIVE Texas House Bill 790 resulted in the expansion of the newborn screening panel from 7 disorders to 27 disorders. Implementation of this change began in 2007. The objective of this study was to estimate the incremental cost-effectiveness of the expanded newborn screening program compared with the previous standard screening in Texas. METHODS A Markov model (for a hypothetical cohort of Texas births in 2007) was constructed to compare lifetime costs and quality-adjusted life-years (QALYs) between the expanded newborn screening and preexpansion newborn screening. Estimates of costs, probabilities of sequelae, and utilities for disorder categories were obtained from a combination of Texas statistics, the literature, and expert opinion. A baseline discount rate of 3% was used for both costs and QALYs, with a range of 0% to 5%. Analyses were conducted from a payer's perspective, and so only direct medical cost estimates were included. RESULTS The lifetime incremental cost-effectiveness ratio for expanded versus preexpansion screening was about $11,560 per QALY. The results remained robust to both deterministic and probabilistic sensitivity analyses. CONCLUSIONS Expanded newborn screening does result in additional expenses to the payer, but it also improves patient outcomes by preventing avoidable morbidity and mortality. The screened population benefits from greater QALYs as compared with the unscreened population. Overall, expanded newborn screening in Texas was estimated to be a cost-effective option as compared with unexpanded newborn screening.
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Barra CB, Silva IN, Pezzuti IL, Januário JN. Neonatal screening for congenital adrenal hyperplasia. Rev Assoc Med Bras (1992) 2012; 58:459-464. [PMID: 22930025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 04/02/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The effectiveness of neonatal screening for reducing morbimortality in children with congenital adrenal hyperplasia (CAH) is the main justification for its implementation. One of the challenges for its implementation is to determine the cutoff value for laboratory measurement of 17-hydroxyprogesterone (17OHP) with appropriate cost-effectiveness. This study identified factors affecting the results of the pilot project of newborn screening for CAH, performed in the state of Minas Gerais, Brazil. METHODS Neonatal screening performed between September, 2007 and May, 2008, with 17OHP measurements performed in blood samples taken from the heel (filter paper), on the 5(th) day of life, processed by the UMELISA 17-OH Progesterona NEONATAL(®) method. The cutoff value was 80 and 160 nmol/L for healthy children or not, respectively. RESULTS The incidence of CAH was 1:19,939 in 159,415 children screened. The 99(th) percentile (p99) of 17OHP in the first sample was 108 nmol/L. In 13,298 newborns whose weight had been reported, the p99 of 17OHP were, respectively: 344 nmol/L for weight < 1,500 g; 260 nmol/L for weight between 1,500 and 1,999 g; 221 nmol/L for weight between 2,000 and 2,499 g; 109 nmol/L for weight ≥ 2,500g. The rate of recall for medical consultation was 0.31%. The test sensitivity was 100%, specificity was 99.6%, and the positive predictive value was 2.2%. By adjusting the cutoff values of 17OHP to 110 nmol/L and 220 nmol/L, a 76% decrease in consultation referrals was projected. CONCLUSION The use of 17OHP cutoff values, considering birth weight, was a cost-effective measure to reduce false positives. The results of this pilot study suggest that screening for CAH might benefit the pediatric population.
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Burgard P, Rupp K, Lindner M, Haege G, Rigter T, Weinreich SS, Loeber JG, Taruscio D, Vittozzi L, Cornel MC, Hoffmann GF. Newborn screening programmes in Europe; arguments and efforts regarding harmonization. Part 2. From screening laboratory results to treatment, follow-up and quality assurance. J Inherit Metab Dis 2012; 35:613-25. [PMID: 22544437 DOI: 10.1007/s10545-012-9484-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 03/13/2012] [Accepted: 03/28/2012] [Indexed: 11/30/2022]
Abstract
In a survey conducted in 2010/2011 data from the 28 EU member states, four EU candidate states (Croatia, FYROM, Iceland, Turkey), three potential EU candidate states (Bosnia Herzegovina, Montenegro, Serbia), and two EFTA states (Norway and Switzerland) were collected. The status and function of newborn screening (NBS) programmes were investigated from the information to prospective parents and the public via confirmation of a positive screening result up to decisions on treatment. This article summarises the results from screening laboratory findings to start of treatment. In addition we asked about the existence of feedback loops reporting the conclusions of confirmation of screening results to the screening laboratory and communication of long-term outcome to diagnostic units and possibly existing central registries. Parallel to the description of actual practices of where, how and by whom the different steps of the programmes are executed, we also asked for the existence of guidelines or directives regulating the screening programmes, material to support information of parents about diagnoses and treatment and training facilities for professionals involved in the programmes. This survey gives a first comprehensive overview of the steps following a positive screening result in European NBS programmes. The 37 data sets reveal substantial variation of national screening panels, but also a lot of similarities. Analysis across all countries revealed that actual practice is often organised but not regulated by guidelines. Material to inform patients is available more often for explaining treatment (69 %) than explaining the necessity of confirmatory diagnostics (41 %). Training of professionals is rarely regulated by a guideline (2 %), but is offered for paediatricians (40 %) and dieticians (29 %) and only rarely for other professions (e.g. geneticists, clinical nurse specialists, psychologists). Registry-based evaluation of long-term outcome is as yet almost nonexistent (3 %).
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Affiliation(s)
- Peter Burgard
- Department of Paediatrics, University Hospital - Heidelberg (DE), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
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Hamers FF, Rumeau-Pichon C. Cost-effectiveness analysis of universal newborn screening for medium chain acyl-CoA dehydrogenase deficiency in France. BMC Pediatr 2012; 12:60. [PMID: 22681855 PMCID: PMC3464722 DOI: 10.1186/1471-2431-12-60] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 06/08/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Five diseases are currently screened on dried blood spots in France through the national newborn screening programme. Tandem mass spectrometry (MS/MS) is a technology that is increasingly used to screen newborns for an increasing number of hereditary metabolic diseases. Medium chain acyl-CoA dehydrogenase deficiency (MCADD) is among these diseases. We sought to evaluate the cost-effectiveness of introducing MCADD screening in France. METHODS We developed a decision model to evaluate, from a societal perspective and a lifetime horizon, the cost-effectiveness of expanding the French newborn screening programme to include MCADD. Published and, where available, routine data sources were used. Both costs and health consequences were discounted at an annual rate of 4%. The model was applied to a French birth cohort. One-way sensitivity analyses and worst-case scenario simulation were performed. RESULTS We estimate that MCADD newborn screening in France would prevent each year five deaths and the occurrence of neurological sequelae in two children under 5 years, resulting in a gain of 128 life years or 138 quality-adjusted life years (QALY). The incremental cost per year is estimated at €2.5 million, down to €1 million if this expansion is combined with a replacement of the technology currently used for phenylketonuria screening by MS/MS. The resulting incremental cost-effectiveness ratio (ICER) is estimated at €7 580/QALY. Sensitivity analyses indicate that while the results are robust to variations in the parameters, the model is most sensitive to the cost of neurological sequelae, MCADD prevalence, screening effectiveness and screening test cost. The worst-case scenario suggests an ICER of €72 000/QALY gained. CONCLUSIONS Although France has not defined any threshold for judging whether the implementation of a health intervention is an efficient allocation of public resources, we conclude that the expansion of the French newborn screening programme to MCADD would appear to be cost-effective. The results of this analysis have been used to produce recommendations for the introduction of universal newborn screening for MCADD in France.
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Affiliation(s)
- Françoise F Hamers
- Department of Economic and Public Health Evaluation, Haute Autorité de Santé (HAS), 2 avenue du Stade de France, Saint-Denis, France
| | - Catherine Rumeau-Pichon
- Department of Economic and Public Health Evaluation, Haute Autorité de Santé (HAS), 2 avenue du Stade de France, Saint-Denis, France
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Zelner I, Shor S, Lynn H, Roukema H, Lum L, Eisinga K, Koren G. Neonatal screening for prenatal alcohol exposure: assessment of voluntary maternal participation in an open meconium screening program. Alcohol 2012; 46:269-76. [PMID: 22440689 DOI: 10.1016/j.alcohol.2011.09.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/12/2011] [Accepted: 09/23/2011] [Indexed: 11/15/2022]
Abstract
Meconium fatty acid ethyl esters (FAEEs) are validated biomarkers of fetal alcohol exposure. Meconium FAEE testing can potentially be used as a screen by health-care professionals to identify neonates at-risk for Fetal Alcohol Spectrum Disorder, thereby permitting diagnostic follow-up of these children and early intervention in those who develop disabilities. The purpose of this study was to assess whether women would willingly partake in a screening program of this nature. This was determined by launching a pilot screening program for prenatal alcohol exposure in a high-risk obstetric unit previously shown to have a high prevalence of FAEE-positive meconium via anonymous meconium testing. The program involved voluntary testing of meconium for FAEEs and long-term developmental follow-up of positive cases through an existing public health program. The participation rate in the screening program was significantly lower than when testing was conducted anonymously (78% vs. 95%, respectively; p < 0.05), and the positivity rate was 3% in contrast to 30% observed under anonymous conditions (p < 0.001). These low rates suggest that the majority of mothers who consumed alcohol in pregnancy refused to participate. We conclude that despite the potential benefits of such screening programs, maternal unwillingness to consent, likely due to fear, embarrassment, and guilt, may limit the effectiveness of meconium testing for population-based open screening, highlighting the need for public education and social marketing efforts for such programs to be of benefit.
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Affiliation(s)
- Irene Zelner
- Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada
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44
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Magnusson G, Bizjajeva S, Haargaard B, Lundström M, Nyström A, Tornqvist K. [Eye screening in the maternity ward is efficient. Time for more distinct Swedish guidelines, according to prospective registry study]. Lakartidningen 2012; 109:694-697. [PMID: 22530467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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45
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Baranov AA. [Development of scientific research and infrastructure as a part of the goals of the programme "pediatrics"]. Vestn Ross Akad Med Nauk 2012:4-8. [PMID: 22988742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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46
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Dixon S, Shackley P, Bonham J, Ibbotson R. Putting a value on the avoidance of false positive results when screening for inherited metabolic disease in the newborn. J Inherit Metab Dis 2012; 35:169-76. [PMID: 21617925 DOI: 10.1007/s10545-011-9354-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/16/2011] [Accepted: 05/18/2011] [Indexed: 10/18/2022]
Abstract
Despite the increase in the number of inherited metabolic diseases that can be detected at birth using a single dried blood spot sample, the impact of false positive results on parents remains a concern. We used an economic approach - the contingent valuation method - which asks parents to give their maximum willingness to pay for an extension in a screening programme and the degree to which the potential for false positive results diminishes their valuations. 160 parents of a child or children under the age of 16 years were surveyed and given descriptions of the current screening programme in the UK, an extended programme and an extended programme with no false positives. 148 (92.5%) respondents said they would accept the screen for the five extra conditions in an expanded screening programme whilst 10 (6.3%) said they would not and two were unsure. When asked to indicate if they would choose to be screened under an expanded screening programme with no false positive results, 152 (95%) said they would, five (3.1%) said they would not, two were unsure, and there was one non-response. 151 (94.4%) said they preferred the hypothetical test with no false-positives. The mean willingness to pay for the expanded programme was £178 compared to £219 for the hypothetical expanded programme without false positives (p > 0.05). The results suggest that there is widespread parental support for extended screening in the UK and that the number of false-positives is a relatively small issue.
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Affiliation(s)
- Simon Dixon
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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47
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Hagopian WA, Erlich H, Lernmark A, Rewers M, Ziegler AG, Simell O, Akolkar B, Vogt R, Blair A, Ilonen J, Krischer J, She J. The Environmental Determinants of Diabetes in the Young (TEDDY): genetic criteria and international diabetes risk screening of 421 000 infants. Pediatr Diabetes 2011; 12:733-43. [PMID: 21564455 PMCID: PMC3315186 DOI: 10.1111/j.1399-5448.2011.00774.x] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS The Environmental Determinants of Diabetes in the Young (TEDDY) study seeks to identify environmental factors influencing the development of type 1 diabetes (T1D) using intensive follow-up of children at elevated genetic risk. This study requires a cost-effective yet accurate screening strategy to identify the high-risk cohort. METHODS The TEDDY cohort was identified through newborn screening using human leukocyte antigen (HLA) class II genes based on criteria established with pre-TEDDY data. HLA typing was completed at six international centers using different genotyping methods that can achieve >98% accuracy. RESULTS TEDDY developed separate inclusion criteria for the general population (GP) and first-degree relatives (FDRs) of T1D patients. The FDR eligibility includes nine haplogenotypes (DR3/4, DR4/4, DR4/8, DR3/3, DR4/4b, DR4/1, DR4/13, DR4/9, and DR3/9) for broad HLA diversity, whereas the GP eligibility includes only the first four haplogenotypes with DRB1*0403 as an exclusion allele. TEDDY has screened 414 714 GP infants, of which 19 906 (4.8%) were eligible, whereas 1415 of the 6333 screened FDR infants (22.2%) were eligible. High-resolution confirmation testing of the eligible subjects indicated that the low-cost and low-resolution genotyping techniques employed at the screening centers yielded an accuracy of 99%. There were considerable variations in eligibility rates among the centers for GP (3.5-7.4%) and FDR (19-32%) subjects. The eligibility rates among US ethnic groups were 0.9, 1.3, 5.0, and 6.9% for Asians, Black, Caucasians, and Hispanics, respectively. CONCLUSIONS Different low-cost and low-resolution genotyping methods are useful for the efficient and accurate identification of a high-risk cohort for follow-up based on the TEDDY HLA inclusion criteria.
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Chan K, Davis J, Pai SY, Bonilla FA, Puck JM, Apkon M. A Markov model to analyze cost-effectiveness of screening for severe combined immunodeficiency (SCID). Mol Genet Metab 2011; 104:383-9. [PMID: 21810544 PMCID: PMC3205197 DOI: 10.1016/j.ymgme.2011.07.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 07/06/2011] [Accepted: 07/06/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of universal neonatal screening for T cell lymphocytopenia in enhancing quality of life and life expectancy for children with severe combined immunodeficiency (SCID). METHODS Decision trees were created and analyzed to estimate the cost, life years, and quality adjusted life years (QALYs) across a population when universal screening for lack of T cells is used to detect SCID, as implemented in five states, compared to detection based on recognizing symptoms and signs of disease. Terminal values of each tree limb were derived through Markov models simulating the natural history of three cohorts: unaffected subjects; those diagnosed with SCID as neonates (early diagnosis); and those diagnosed after becoming symptomatic and arousing clinical suspicion (late diagnosis). Models considered the costs of screening and of care including hematopoietic cell transplantation for affected individuals. Key decision variables were derived from the literature and from a survey of families with children affected by SCID, which was used to describe the clinical history and healthcare utilization for affected subjects. Sensitivity analyses were conducted to explore the influence of these decision variables. RESULTS Over a 70-year time horizon, the average cost per infant was $8.89 without screening and $14.33 with universal screening. The model predicted that universal screening in the U.S. would cost approximately $22.4 million/year with a gain of 880 life years and 802 QALYs. Sensitivity analyses showed that screening test specificity and disease incidence were critical driving forces affecting the incremental cost-effectiveness ratio (ICER). Assuming a SCID incidence of 1/75,000 births and test specificity and sensitivity each at 0.99, screening remained cost-effective up to a maximum cost of $15 per infant screened. CONCLUSION At our current estimated screening cost of $4.22/infant, universal screening for SCID would be a cost effective means to improve quality and duration of life for children with SCID.
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Affiliation(s)
- Kee Chan
- Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA 02215, USA.
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Said RN, Zaki MM, Abdelrazik MB. Congenital toxoplasmosis: evaluation of molecular and serological methods for achieving economic and early diagnosis among Egyptian preterm infants. J Trop Pediatr 2011; 57:333-9. [PMID: 20961951 DOI: 10.1093/tropej/fmq097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early diagnosis of congenital toxoplasmosis (CT) is difficult when specific immunoglobulin M (IgM) antibodies are absent, or if persist for months, in the newborn infant's blood. OBJECTIVES To study the risk factors of neonatal toxoplasmosis and to compare different immunologic profiles (Toxoplasma-specific IgM, IgA antibodies and the avidity of IgG antibodies) with polymerase chain reaction (PCR) for reaching economic and early postnatal diagnosis. MATERIALS AND METHODS We prospectively studied 80 preterm neonates, recruited from neonatal intensive care units (NICUs) of Cairo University hospitals. Whose gestational age ≤ 34 weeks with (n = 60) or without (n = 20) CT risk. Serum samples for specific IgA, IgM antibodies and avidity of IgG toxoplasma antibodies were measured by ELISA then compared to PCR. RESULTS Of the 60 studied cases, 16 (26.7%) were positive for toxoplasmosis by PCR, of which 15 (25%) had low avidity of IgG antibodies (positive), 14 (23.3%) were positive for IgA and 10 (16.7%) were positive for IgM, with sensitivity for avidity of IgG, IgA and IgM: 93.2%, 87.5% and 62.5%, respectively. CONCLUSION Determination of avidity of IgG toxoplasma antibodies and/or serological detection of specific IgA for toxoplasmosis offer, simple tests for diagnosis of congenital toxoplasmosis with (better sensitivity) than IgM.
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MESH Headings
- Antibodies, Protozoan/blood
- Antibody Affinity
- Early Diagnosis
- Egypt
- Enzyme-Linked Immunosorbent Assay
- Female
- Humans
- Immunoglobulin A/blood
- Immunoglobulin G/blood
- Immunoglobulin M/blood
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/blood
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/immunology
- Male
- Neonatal Screening/economics
- Neonatal Screening/methods
- Polymerase Chain Reaction
- Prospective Studies
- Risk Factors
- Sensitivity and Specificity
- Toxoplasma/immunology
- Toxoplasmosis, Congenital/blood
- Toxoplasmosis, Congenital/diagnosis
- Toxoplasmosis, Congenital/immunology
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Affiliation(s)
- Reem N Said
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt.
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50
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O'Brien ML, Phillips SM. Substance exposed newborns: addressing social costs across the lifespan. Issue Brief (Mass Health Policy Forum) 2011:1-49. [PMID: 21998906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Margaret L O'Brien
- Heller School for Social Policy and Management, Brandeis University, USA
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