Published online May 1, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. S280-S286 (doi:10.1542/peds.2005-2633G)
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SUPPLEMENT ARTICLE

Economic Evaluation of Tandem Mass Spectrometry Screening in California

Lisa Feuchtbaum, DrPH, MPH and George Cunningham, MD, MPH

Genetic Disease Branch, California Department of Health Services, Richmond, California

OBJECTIVE. On the basis of California’s experience implementing a pilot tandem mass spectrometry (MS/MS) screening program, an economic evaluation was conducted to determine the economic benefits and costs of a statewide MS/MS screening program.

METHODS. Cost-effectiveness, benefit/cost, and cost-utility analyses were conducted with a base-case set of assumptions. The base-case assumptions were varied by using a set of more-favorable and less-favorable assumptions to test the robustness of the analysis findings.

RESULTS. The total estimated, annualized, incremental costs of MS/MS screening of 540000 births in California were nearly $5.7 million; 83 affected newborns would be identified. Screening would reduce the expected lifetime costs of medical care for affected newborns by $7.2 million ($9.0 million in the best-case scenario and $1.8 million in the worst-case scenario). When all program costs and savings were considered, screening saved $1.5 million ($3.4 million saved in the best-case scenario and $3.8 million additional costs in the worst-case scenario). With only incremental program costs, the cost per life saved was $708000 and the cost per case detected was $68000. With consideration of the projected lifetime medical care costs, the total cost per case detected was $132000. MS/MS screening produced a benefit/cost ratio of $9.32 ($11.67 with the best-case set of assumptions and $4.34 with the worst-case set of assumptions). In this analysis, the benefits of screening exceeded total program costs by $47.1 million (the net incremental benefit). In the worst-case scenario, the net incremental benefit of screening was $18.9 million. Screening saved 949 quality-adjusted life-years (QALYs) and saved $1628 per QALY in the base case analysis. Under the worst-case scenario, the cost per QALY was $14922.

CONCLUSIONS. We found that the benefits of MS/MS screening outweighed the costs and that the net benefits were significant and robust in various scenarios with various conservative underlying assumptions.

Key Words: Key Words • newborn screening • economics • cost-utility

Abbreviations: MS/MS—tandem mass spectrometry • QALY—quality-adjusted life-year • PKU—phenylketonuria • CDC—Centers for Disease Control and Prevention

Accepted Dec 27, 2005.