Cost-benefit analysis of a neonatal screening program for congenital hypothyroidism in Metro Manila

ABSTRACT

BACKGROUND: Neonatal mass screening has led to the early diagnosis and management of congenital endocrine and metabolic diseases. The effectiveness and efficiency of neonatal screening had been well established for congenital hypothyroidism (CH) in other settings. OBJECTIVES: 1) To determine the incidence of CH; and 2) To determine whether a newborn screening program (NSP) for CH is cost-beneficial from a societal perspective. DESIGN: Screening survey with cost-benefit analysis. SUBJECTS AND METHODS: Newborns from the original 24 hospitals in Metro Manila that started newborn screening were screened for CH after the 48th hour of life. Confirmatory tests were performed for those who screened positive. Using the incidence from the survey, the costs for the detection and treatment of CH were compared to the projected benefits of preventing the mental retardation and consequent productivity losses. Sensitivity analyses for incidence rates, discount rates and timing of blood collection were included. RESULTS: A total of 28,088 newborns (40% of 69,391 live births) were screened. Ninety-two were recalled for confirmatory testing after the initial screen; 8 were diagnosed with CH. Assuming that a cohort of 200,000 newborns would be screened in one year, the net costs for the screening program were US$ 2.4M. If the timing of blood collection was after the 24th hour, there was instead a net benefit of US$ 0.6M. The incidence of CH among the hospital admissions in Metro Manila was 0.037% (95% CI 0.009 - 0.064%). CONCLUSIONS: The net cost of a screening program for CH taken after 48 hours was US$ 2.4M. Newborn screening for CH was cost-beneficial if blood collection occurred after the 24th hour so that expense of an additional hospital day was not incurred. In order to realize the costing benefits illustrated by this study, the timing of sample collection was moved to a day earlier (after 24 hours of age) beginning in 2000.