Panepinto J A, Magid D, Rewers M J, Lane P A
Colorado Sickle Cell Treatment and Research Center and the Departments of Pediatrics and Preventive Medicine and Biometrics, University of Colorado School of Medicine, Denver, CO 80262, USA.
J Pediatr. 2000 Feb;136(2):201-8. doi: 10.1016/s0022-3476(00)70102-8.
To compare the health outcomes, costs, and incremental cost-effectiveness of universal neonatal screening for sickle cell disease (SCD) with screening targeted to African Americans.
A cost-effectiveness analysis was done by using a Markov simulation model that considered the costs and outcomes associated with the prevention and treatment of sepsis in those with sickle cell anemia and sickle beta(0)-thalassemia. Three strategies were compared: (1) no screening, (2) targeted screening of African Americans, and (3) universal screening for SCD.
In the base case analysis, targeted screening of African Americans compared with no screening cost $6709 per additional year of life saved, and universal screening compared with targeted screening cost $30,760 per additional year of life saved. In a sensitivity analysis, the cost per additional year of life saved with universal screening compared with targeted screening was positively correlated with the delivery rate of targeted screening and was inversely related to the proportion of African Americans in the population.
Targeted screening of African American newborns for SCD compared with no screening is always cost-effective. Universal screening compared with targeted screening always identifies more infants with disease, prevents more deaths, and is cost-effective given certain delivery rates for targeted screening and proportions of African Americans in the population.
比较镰状细胞病（SCD）普遍新生儿筛查与针对非裔美国人的筛查的健康结局、成本及增量成本效益。
采用马尔可夫模拟模型进行成本效益分析，该模型考虑了镰状细胞贫血和镰状β（0）-地中海贫血患者败血症预防和治疗的成本及结局。比较了三种策略：（1）不筛查，（2）针对非裔美国人的靶向筛查，（3）SCD普遍筛查。
在基础病例分析中，与不筛查相比，针对非裔美国人的靶向筛查每多挽救一年生命的成本为6709美元，与靶向筛查相比，普遍筛查每多挽救一年生命的成本为30760美元。在敏感性分析中，与靶向筛查相比，普遍筛查每多挽救一年生命的成本与靶向筛查的实施率呈正相关，与人群中非裔美国人的比例呈负相关。
与不筛查相比，针对非裔美国新生儿进行SCD靶向筛查始终具有成本效益。与靶向筛查相比，普遍筛查总能识别出更多患病婴儿，预防更多死亡，并且在靶向筛查的特定实施率和人群中非裔美国人的比例情况下具有成本效益。
