Newborn screening and prophylactic interventions for sickle cell disease in 47 countries in sub-Saharan Africa: a cost-effectiveness analysis
Newborn screening and prophylactic interventions for sickle cell disease in 47 countries in sub-Saharan Africa: a cost-effectiveness analysis
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DOI：
10.1186/s12913-016-1572-6
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发表时间：
2016-07-26
影响因子：
2.8
通讯作者：
Lamorde, Mohammed
中科院分区：
文献类型：
--
作者：
Kuznik, Andreas;Habib, Abdulrazaq G.;Lamorde, Mohammed
背景：镰状细胞病（SCD）是撒哈拉以南非洲（SSA）的一个主要公共卫生问题。新生儿筛查和早期后续临床干预可以降低早期死亡率和增加预期寿命，但尚未在SSA中广泛实施。本分析评估的成本效益的新生儿筛查和预防性干预（NSPI）包SCD在47 SSA countries.Methods：一个终身马尔可夫模型与每年的周期与婴儿被筛选使用等电聚焦（IEF）或不筛选。确诊的阳性病例接受了干预措施，包括驱虫蚊帐、叶酸补充剂、预防性抗疟和青霉素治疗以及预防细菌感染的疫苗接种。SCD的当地发病率、未治疗儿童的预期寿命、SCD残疾体重和筛查实验室检查的费用的估计是基于已发表的资料。在接受治疗的婴儿中，直至30岁的年死亡概率来自儿科医院队列。结果的利益包括国家特定的成本每残疾调整生命年（DALY averted.Results）的47个模拟国家在SSA，NSPI几乎肯定是高度成本效益在24个国家（避免的每个残疾调整生命年的平均费用：184美元）;在10个国家，在基本情况下具有成本效益（避免的每个残疾调整生命年的平均费用：285美元），但结果不确定;在其余13个国家，很可能不符合成本效益。我们观察到SCD的发病率和每DALY避免的成本之间有很强的反比关系。据估计，只要发病率超过0.2- 0.3%，新生儿筛查就具有成本效益，尽管在一些国家，NSPI在发病率低于这一范围时具有成本效益。总之，NSPI可以避免超过240万残疾调整生命年（DSPs）每年在SAS.Conclusions：使用IEF筛选所有新生儿SCD加上管理的预防性干预措施，受影响的儿童是具有成本效益的大多数国家在SSA。
Background: Sickle cell disease (SCD) constitutes a major public health problem in sub-Saharan Africa (SSA). Newborn screening and early subsequent clinical intervention can reduce early mortality and increase life expectancy, but have not been widely implemented in SSA. This analysis assesses the cost-effectiveness of a newborn screening and prophylactic intervention (NSPI) package for SCD in 47 SSA countries.Methods: A lifetime Markov model with annual cycles was built with infants either being screened using isoelectric focusing (IEF) or not screened. Confirmed positive cases received interventions including insecticide-treated mosquito bed nets, folic acid supplementation, prophylactic antimalarial and penicillin therapy, and vaccinations against bacterial infections. Estimates for the local incidence of SCD, the life expectancy of untreated children, the SCD disability weight, and the cost of screening laboratory tests were based on published sources. Among treated infants, the annual probability of mortality until 30 years of age was derived from a pediatric hospital-based cohort. The outcome of interest included a country-specific cost per Disability Adjusted Life Year (DALY) averted.Results: Of 47 modeled countries in SSA, NSPI is almost certainly highly cost-effective in 24 countries (average cost per DALY averted: US$184); in 10 countries, it is cost-effective in the base case (average cost per DALY averted: US$285), but the results are subject to uncertainty; in the remaining 13, it is most likely not cost-effective. We observe a strong inverse relationship between the incidence rate of SCD and the cost per DALY averted. Newborn screening is estimated to be cost-effective as long as the incidence rate exceeds 0.2-0.3 %, although in some countries NSPI is cost-effective at incidence rates below this range. In total, NSPI could avert over 2.4 million disability adjusted life years (DALYs) annually across SSA.Conclusions: Using IEF to screen all newborns for SCD plus administration of prophylactic interventions to affected children is cost-effective in the majority of countries in SSA.