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Rivero-Arias O, Png ME, White A, Yang M, Taylor-Phillips S, Hinton L, Boardman F, McNiven A, Fisher J, Thilaganathan B, Oddie S, Slowther AM, Ratushnyak S, Roberts N, Shilton Osborne J, Petrou S. Benefits and harms of antenatal and newborn screening programmes in health economic assessments: the VALENTIA systematic review and qualitative investigation. Health Technol Assess 2024; 28:1-180. [PMID: 38938110 PMCID: PMC11228689 DOI: 10.3310/pytk6591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background Health economic assessments are used to determine whether the resources needed to generate net benefit from an antenatal or newborn screening programme, driven by multiple benefits and harms, are justifiable. It is not known what benefits and harms have been adopted by economic evaluations assessing these programmes and whether they omit benefits and harms considered important to relevant stakeholders. Objectives (1) To identify the benefits and harms adopted by health economic assessments in this area, and to assess how they have been measured and valued; (2) to identify attributes or relevance to stakeholders that ought to be considered in future economic assessments; and (3) to make recommendations about the benefits and harms that should be considered by these studies. Design Mixed methods combining systematic review and qualitative work. Systematic review methods We searched the published and grey literature from January 2000 to January 2021 using all major electronic databases. Economic evaluations of an antenatal or newborn screening programme in one or more Organisation for Economic Co-operation and Development countries were considered eligible. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. We identified benefits and harms using an integrative descriptive analysis and constructed a thematic framework. Qualitative methods We conducted a meta-ethnography of the existing literature on newborn screening experiences, a secondary analysis of existing individual interviews related to antenatal or newborn screening or living with screened-for conditions, and a thematic analysis of primary data collected with stakeholders about their experiences with screening. Results The literature searches identified 52,244 articles and reports, and 336 unique studies were included. Thematic framework resulted in seven themes: (1) diagnosis of screened for condition, (2) life-years and health status adjustments, (3) treatment, (4) long-term costs, (5) overdiagnosis, (6) pregnancy loss and (7) spillover effects on family members. Diagnosis of screened-for condition (115, 47.5%), life-years and health status adjustments (90, 37.2%) and treatment (88, 36.4%) accounted for most of the benefits and harms evaluating antenatal screening. The same themes accounted for most of the benefits and harms included in studies assessing newborn screening. Long-term costs, overdiagnosis and spillover effects tended to be ignored. The wide-reaching family implications of screening were considered important to stakeholders. We observed good overlap between the thematic framework and the qualitative evidence. Limitations Dual data extraction within the systematic literature review was not feasible due to the large number of studies included. It was difficult to recruit healthcare professionals in the stakeholder's interviews. Conclusions There is no consistency in the selection of benefits and harms used in health economic assessments in this area, suggesting that additional methods guidance is needed. Our proposed thematic framework can be used to guide the development of future health economic assessments evaluating antenatal and newborn screening programmes. Study registration This study is registered as PROSPERO CRD42020165236. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127489) and is published in full in Health Technology Assessment; Vol. 28, No. 25. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - May Ee Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ashley White
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Miaoqing Yang
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- THIS Institute, University of Cambridge, Cambridge, UK
| | | | - Abigail McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Sam Oddie
- Bradford Institute for Health Research, Bradford Children's Research, Bradford, UK
| | | | - Svetlana Ratushnyak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Jenny Shilton Osborne
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Lombardo S, Seedat F, Elliman D, Marshall J. Policy-making and implementation for newborn bloodspot screening in Europe: a comparison between EURORDIS principles and UK practice. THE LANCET REGIONAL HEALTH. EUROPE 2023; 33:100714. [PMID: 37954001 PMCID: PMC10636270 DOI: 10.1016/j.lanepe.2023.100714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 11/14/2023]
Abstract
Newborn bloodspot screening (NBS) policy is a contentious area in Europe. Variation in the screening panels on offer, in the approach to evidence assessment and in the use of health economic modelling are some of the issues which are debated on the topic. In this paper we focus on a set of patient-driven principles for newborn screening published by EURORDIS and use these as a reference point for exploration and comparison with NBS policy development and screening practice in the UK. In doing so, we share UK practice; we note the UK is generally well aligned with many of the recommended principles, but we also discuss areas of controversy and challenges. Some of these, like 'actionability', will undoubtedly continue to be debated and may never reach consensus. For others, such as patient and public voice participation in newborn screening systems, there are opportunities to continue improving existing processes and developing new mechanisms for stakeholder participation. Screening bodies in other European countries should also compare their policy-making and implementation practices with the EURORDIS principles to stimulate further discussion on the challenges and opportunities of newborn screening and provide a cross-European baseline.
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Affiliation(s)
- Silvia Lombardo
- UK National Screening Committee, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| | - Farah Seedat
- St. George’s, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - David Elliman
- UK National Screening Committee, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| | - John Marshall
- UK National Screening Committee, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
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Png ME, Yang M, Taylor-Phillips S, Ratushnyak S, Roberts N, White A, Hinton L, Boardman F, McNiven A, Fisher J, Thilaganathan B, Oddie S, Slowther AM, Shilton Osborne J, Petrou S, Rivero-Arias O. Benefits and harms adopted by health economic assessments evaluating antenatal and newborn screening programmes in OECD countries: A systematic review of 336 articles and reports. Soc Sci Med 2022; 314:115428. [PMID: 36272385 PMCID: PMC9720154 DOI: 10.1016/j.socscimed.2022.115428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/12/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Health economic assessments are used to determine whether the resources needed to generate net benefit from a screening programme, driven by multiple complex benefits and harms, are justifiable. We systematically identified the benefits and harms incorporated within economic assessments evaluating antenatal and newborn screening programmes. METHODS For this systematic review and thematic analysis, we searched the published and grey literature from January 2000 to January 2021. Studies that included an economic evaluation of an antenatal or newborn screening programme in an OECD country were eligible. We identified benefits and harms using an integrative descriptive analysis, and illustrated a thematic framework. (Systematic review registration PROSPERO, CRD42020165236). FINDINGS The searches identified 52,244 articles and reports and 336 (242 antenatal and 95 newborn) were included. Eighty-six subthemes grouped into seven themes were identified: 1) diagnosis of screened for condition, 2) life years and health status adjustments, 3) treatment, 4) long-term costs, 5) overdiagnosis, 6) pregnancy loss, and 7) spillover effects on family members. Diagnosis of screened for condition (115 studies, 47.5%), life-years and health status adjustments (90 studies, 37.2%) and treatment (88 studies, 36.4%) accounted for most of the benefits and harms evaluating antenatal screening. The same themes accounted for most of the benefits and harms included in studies assessing newborn screening. Overdiagnosis and spillover effects tended to be ignored. INTERPRETATION Our proposed framework can be used to guide the development of future health economic assessments evaluating antenatal and newborn screening programmes, to prevent exclusion of important potential benefits and harms.
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Affiliation(s)
- May Ee Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Miaoqing Yang
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Svetlana Ratushnyak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Ashley White
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lisa Hinton
- THIS Institute, University of Cambridge, Cambridge, UK
| | | | - Abigail McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Sam Oddie
- Bradford Institute for Health Research, Bradford Children's Research, Bradford, UK
| | | | - Jenny Shilton Osborne
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK,Corresponding author. National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Old Road Campus, University of Oxford, OX3 7LF, UK
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Verkleij ML, Heijnsdijk EAM, Bussé AML, Carr G, Goedegebure A, Mackey AR, Qirjazi B, Uhlén IM, Sloot F, Hoeve HLJ, de Koning HJ. Cost-Effectiveness of Neonatal Hearing Screening Programs: A Micro-Simulation Modeling Analysis. Ear Hear 2021; 42:909-916. [PMID: 33306547 PMCID: PMC8221716 DOI: 10.1097/aud.0000000000000981] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Early detection of neonatal hearing impairment moderates the negative effects on speech and language development. Universal neonatal hearing screening protocols vary in tests used, timing of testing and the number of stages of screening. This study estimated the cost-effectiveness of various protocols in the preparation of implementation of neonatal hearing screening in Albania.
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Affiliation(s)
- Mirjam L Verkleij
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrea M L Bussé
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gwen Carr
- Independent Consultant in Early Hearing Detection, Intervention and Family Centered Practice, London, United Kingdom
| | - André Goedegebure
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Allison R Mackey
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Birkena Qirjazi
- Department of Ear, Nose and Throat Diseases-Ophthalmology, University of Tirana, Tirana, Albania
| | - Inger M Uhlén
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Frea Sloot
- Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hans L J Hoeve
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Cacciatore P, Visser LA, Buyukkaramikli N, van der Ploeg CPB, van den Akker-van Marle ME. The Methodological Quality and Challenges in Conducting Economic Evaluations of Newborn Screening: A Scoping Review. Int J Neonatal Screen 2020; 6:ijns6040094. [PMID: 33238605 PMCID: PMC7712813 DOI: 10.3390/ijns6040094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Cost-effectiveness (CEA) and cost-utility analyses (CUA) have become popular types of economic evaluations (EE) used for evidence-based decision-making in healthcare resource allocation. Newborn screening programs (NBS) can have significant clinical benefits for society, and cost-effectiveness analysis may help to select the optimal strategy among different screening programs, including the no-screening option, on different conditions. These economic analyses of NBS, however, are hindered by several methodological challenges. This study explored the methodological quality in recent NBS economic evaluations and analyzed the main challenges and strategies adopted by researchers to deal with them. METHODS A scoping review was conducted according to PRISMA methodology to identify CEAs and CUAs of NBS. The methodological quality of the retrieved studies was assessed quantitatively using a specific guideline for the quality assessment of NBS economic evaluations, by calculating a general score for each EE. Challenges in the studies were then explored using thematic analysis as a qualitative synthesis approach. RESULTS Thirty-five studies met the inclusion criteria. The quantitative analysis showed that the methodological quality of NBS economic evaluations was heterogeneous. Lack of clear description of items related to results, discussion, and discounting were the most frequent flaws. Methodological challenges in performing EEs of neonatal screenings include the adoption of a long time horizon, the use of quality-adjusted life years as health outcome measure, and the assessment of costs beyond the screening interventions. CONCLUSIONS The results of this review can support future economic evaluation research, aiding researchers to develop a methodological guidance to perform EEs aimed at producing solid results to inform decisions for resource allocation in neonatal screening.
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Affiliation(s)
- Pasquale Cacciatore
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Laurenske A. Visser
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands; (L.A.V.); (N.B.)
| | - Nasuh Buyukkaramikli
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands; (L.A.V.); (N.B.)
| | | | - M. Elske van den Akker-van Marle
- Unit Medical Decision Making, Department of Biomedical Datasciences, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence:
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Automated generation of decision-tree models for the economic assessment of interventions for rare diseases using the RaDiOS ontology. J Biomed Inform 2020; 110:103563. [PMID: 32931923 DOI: 10.1016/j.jbi.2020.103563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/31/2020] [Accepted: 09/05/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The development of decision models to assess interventions for rare diseases require huge efforts from research groups, especially regarding collecting and synthesizing the knowledge to parameterize the model. This article presents a method to reuse the knowledge collected in an ontology to automatically generate decision tree models for different contexts and interventions. MATERIAL AND METHODS We updated the reference ontology (RaDiOS) to include more knowledge required to generate a model. We implemented a transformation tool (RaDiOS-MTT) that uses the knowledge stored in RaDiOS to automatically generate decision trees for the economic assessment of interventions on rare diseases. RESULTS We used a case study to illustrate the potential of the tool, and automatically generate a decision tree that reproduces an actual study on newborn screening for profound biotinidase deficiency. CONCLUSIONS RaDiOS-MTT allows research groups to reuse the evidence collected, and thus speeding up the development of health economics assessments for interventions on rare diseases.
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Yadav S, Gettu N, Swain B, Kumari K, Ojha N, Gunthe SS. Bioaerosol impact on crop health over India due to emerging fungal diseases (EFDs): an important missing link. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:12802-12829. [PMID: 32124300 DOI: 10.1007/s11356-020-08059-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/10/2020] [Indexed: 06/10/2023]
Abstract
Atmospheric bioaerosols, which contain a diverse group of various biological materials, also include pathogenic microorganisms such as viruses, bacteria, and fungal spores. The dispersal of various pathogens negatively impacts the human and ecosystem health. While the impact of pathogenic bacteria and viruses on human and ecosystem health is well documented, the impact of fungal spores on crop, however, is poorly characterized. An unprecedented increase in number of fungal and fungal-like diseases (emerging fungal diseases (EFDs)) in plants is threatening the food security and endangering the biodiversity. In present communication, we show an increasing trend in the fungal bioaerosol attacks on crops over India outstripping bacteria and viruses. We further argue about the complex interactions between the fungal species, and crop impact over India is unique and highly interconnected with the topography, meteorological variables, and season of the year. Under constantly warming scenario, the fungal attacks on plants are expected to rise and, in all likelihood, extend to the sensitive and fragile ecosystems like the Himalayan region and the Western Ghats. An increasing trend in EFDs calls for immediate coordinated efforts towards understanding the type and diversity of pathogenic fungal bioaerosols. There is, however, a lack over Indian region about biogeography of pathogenic fungi. The detailed biogeography would help in improving public and political awareness to formulate the effective policy decisions. Any further disregard and delay in recognizing the importance of EFDs to crop and sensitive ecosystems can have severe societal and ecological repercussions over Indian region.
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Affiliation(s)
- Shweta Yadav
- Department of Environmental Sciences, Central University of Jammu, Bagla, Rahya Suchani, Samba, 181 143, India
| | - Navin Gettu
- EWRE Division, Department of Civil Engineering, Indian Institute of Technology Madras, Chennai, 600 036, India
| | - Basudev Swain
- EWRE Division, Department of Civil Engineering, Indian Institute of Technology Madras, Chennai, 600 036, India
| | - Kiran Kumari
- Department of Environmental Sciences, Central University of Jammu, Bagla, Rahya Suchani, Samba, 181 143, India
| | - Narendra Ojha
- Space and Atmospheric Science Division, Physical Research Laboratory, Navrangpura, Ahmedabad, 380 009, India
| | - Sachin S Gunthe
- EWRE Division, Department of Civil Engineering, Indian Institute of Technology Madras, Chennai, 600 036, India.
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Carsley S, Fu R, Borkhoff CM, Reid N, Baginska E, Birken CS, Maguire JL, Hancock-Howard R, Parkin PC, Coyte PC. Iron deficiency screening for children at 18 months: a cost-utility analysis. CMAJ Open 2019; 7:E689-E698. [PMID: 31796510 PMCID: PMC6890493 DOI: 10.9778/cmajo.20190084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The peak prevalence of iron deficiency is in children 6 months to 3 years of age, a sensitive period for neurodevelopment. Our study objective was to examine the cost-utility of a proposed iron deficiency screening program for 18-month-old children. METHODS We used a decision tree model to estimate the costs in 2019 Canadian dollars and quality-adjusted life years (QALYs) associated with 3 iron deficiency screening strategies: no screening, universal screening and targeted screening for a high-risk population. We used a societal perspective and assessed lifetime QALY gains. We derived outcomes from the literature and prospectively collected data. We performed one-way and probabilistic sensitivity analyses to assess parameter uncertainty. RESULTS The incremental costs to society of universal and targeted screening programs compared to no screening were $2286.06/QALY and $1676.94/QALY, respectively. With a willingness-to-pay threshold of $50 000/QALY, both programs were cost-effective. Compared to a targeted screening program, a universal screening program would cost an additional $2965.96 to gain 1 QALY, which renders it a cost-effective option. The study findings were robust to extensive sensitivity analyses. INTERPRETATION A proposed universal screening program for iron deficiency would be cost-effective over the lifespan compared to both no screening (current standard of care) and a targeted screening program for children at high risk. Policy-makers and physicians may consider expanding the recommended 18-month enhanced well-baby visit to include screening for iron deficiency.
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Affiliation(s)
- Sarah Carsley
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont.
| | - Rui Fu
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Cornelia M Borkhoff
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Nadine Reid
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Eva Baginska
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Catherine S Birken
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Jonathon L Maguire
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Rebecca Hancock-Howard
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Patricia C Parkin
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Peter C Coyte
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
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Sharma R, Gu Y, Ching TYC, Marnane V, Parkinson B. Economic Evaluations of Childhood Hearing Loss Screening Programmes: A Systematic Review and Critique. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:331-357. [PMID: 30680698 PMCID: PMC7279710 DOI: 10.1007/s40258-018-00456-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Permanent childhood hearing loss is one of the most common birth conditions associated with speech and language delay. A hearing screening can result in early detection and intervention for hearing loss. OBJECTIVES To update and expand previous systematic reviews of economic evaluations of childhood hearing screening strategies, and explore the methodological differences. DATA SOURCES MEDLINE, Embase, the Cochrane database, National Health Services Economic Evaluation Database (NHS EED), the Health Technology Assessment (HTA) database, and Canadian Agency for Drugs and Technologies in Health's (CADTH) Grey matters. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Economic evaluations reporting costs and outcomes for both the intervention and comparator arms related to childhood hearing screening strategies. RESULTS Thirty evaluations (from 29 articles) were included for review. Several methodological issues were identified, including: few evaluations reported outcomes in terms of quality-adjusted life years (QALYs); none estimated utilities directly from surveying children; none included disutilities and costs associated with adverse events; few included costs and outcomes that differed by severity; few included long-term estimates; none considered acquired hearing loss; some did not present incremental results; and few conducted comprehensive univariate or probabilistic sensitivity analysis. Evaluations published post-2011 were more likely to report QALYs and disability-adjusted life years (DALYs) as outcome measures, include long-term treatment and productivity costs, and present incremental results. LIMITATIONS We were unable to access the economic models and, although we employed an extensive search strategy, potentially not all relevant economic evaluations were identified. CONCLUSIONS AND IMPLICATIONS Most economic evaluations concluded that childhood hearing screening is value for money. However, there were significant methodological limitations with the evaluations.
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Affiliation(s)
- Rajan Sharma
- Macquarie University Centre for the Health Economy, Sydney, NSW, Australia.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Sydney, NSW, Australia
- Department of Economics and Related Studies, University of York, York, UK
| | - Teresa Y C Ching
- National Acoustic Laboratories, Australian Hearing Hub, Sydney, NSW, Australia
| | - Vivienne Marnane
- National Acoustic Laboratories, Australian Hearing Hub, Sydney, NSW, Australia
| | - Bonny Parkinson
- Macquarie University Centre for the Health Economy, Sydney, NSW, Australia
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Prieto-González D, Castilla-Rodríguez I, González E, Couce ML. Towards the automated economic assessment of newborn screening for rare diseases. J Biomed Inform 2019; 95:103216. [PMID: 31128259 DOI: 10.1016/j.jbi.2019.103216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Economic assessments of newborn screening programs for rare diseases involve the use of models and require huge efforts to synthesize information from different sources. Sharing and automatically or semi-automatically reusing this information for new assessments would be desirable, but it is not possible nowadays due to the lack of suitable tools. MATERIAL AND METHODS We designed and implemented the Rare Diseases Ontology for Simulation (RaDiOS) after performing two reviews, and critically appraising the existing data repositories on rare diseases. The first review involved previous published economic assessments, and served to identify the main parameters required to model newborn screening. The second review aimed at locating existing data repositories potentially available to inform these parameters. RESULTS We found key model parameters on epidemiology, screening methods, diagnose methods, pathogenesis, treatment and follow-up tests. We also identified seven data repositories directly related to rare diseases. None of such repositories was well-suited for the automated generation of simulation models. We incorporated the identified parameters as structured classes and properties of the new ontology (RaDiOS). We carefully set the relationships among the parameters so to allow automated inference from the ontology. CONCLUSIONS RaDiOS is an ontology that serves as a data repository to automatically build simulation models for the economic assessment of newborn screening for rare diseases.
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Affiliation(s)
- David Prieto-González
- Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna, Avda. Astrofísico Fco. Sánchez s/n, 38200, AP 456., La Laguna, Canary Islands, Spain
| | - Iván Castilla-Rodríguez
- Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna, Avda. Astrofísico Fco. Sánchez s/n, 38200, AP 456., La Laguna, Canary Islands, Spain; Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Tenerife, Spain.
| | - Evelio González
- Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna, Avda. Astrofísico Fco. Sánchez s/n, 38200, AP 456., La Laguna, Canary Islands, Spain
| | - María L Couce
- Unidad de Diagnóstico y Tratamiento de Enfermedades Metabólicas Congénitas, Servicio de Neonatología, Hospital Clínico Universitario de Santiago, Departamento de Pediatría, IDIS, CIBERER, Santiago de Compostela, La Coruña, Spain
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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: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [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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Grosse SD, Mason CA, Gaffney M, Thomson V, White KR. What Contribution Did Economic Evidence Make to the Adoption of Universal Newborn Hearing Screening Policies in the United States? Int J Neonatal Screen 2018; 4:25. [PMID: 30123850 PMCID: PMC6094389 DOI: 10.3390/ijns4030025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Universal newborn hearing screening (UNHS), when accompanied by timely access to intervention services, can improve language outcomes for children born deaf or hard of hearing (D/HH) and result in economic benefits to society. Early Hearing Detection and Intervention (EHDI) programs promote UNHS and using information systems support access to follow-up diagnostic and early intervention services so that infants can be screened no later than 1 month of age, with those who do not pass their screen receiving diagnostic evaluation no later than 3 months of age, and those with diagnosed hearing loss receiving intervention services no later than 6 months of age. In this paper, we first document the rapid roll-out of UNHS/EHDI policies and programs at the national and state/territorial levels in the United States between 1997 and 2005. We then review cost analyses and economic arguments that were made in advancing those policies in the United States. Finally, we examine evidence on language and educational outcomes that pertain to the economic benefits of UNHS/EHDI. In conclusion, although formal cost-effectiveness analyses do not appear to have played a decisive role, informal economic assessments of costs and benefits appear to have contributed to the adoption of UNHS policies in the United States.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop E-87, Atlanta, GA 30341, USA;
| | - Craig A Mason
- College of Education and Human Development, University of Maine, Orono, ME 00469, USA;
| | - Marcus Gaffney
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop E-87, Atlanta, GA 30341, USA;
| | - Vickie Thomson
- Department of Otolaryngology, University of Colorado Denver, Denver, CO 80045, USA;
| | - Karl R White
- National Center for Hearing Assessment and Management (NCHAM), Utah State University, Logan, UT 84322, USA;
- Department of Psychology, Utah State University, Logan, UT 84322, USA
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Cost-Effectiveness Methods and Newborn Screening Assessment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1031:267-281. [PMID: 29214578 DOI: 10.1007/978-3-319-67144-4_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Nowadays, health funding decisions must be supported by sound arguments in terms of both effectiveness and economic criteria. After more than half a century of newborn screening for rare diseases, the appropriate economic evaluation framework for these interventions is still challenging. The validity of standard methods for economic evaluation heavily relies on the availability of robust evidence, but collection of such evidence is precluded by the rareness of the conditions that may benefit from screening. Furthermore, there are a series of conceptual and methodological limitations that warrant further careful consideration when assessing the cost-effectiveness of newborn screening programs. In this chapter we provide a general overview of current economic evaluation methods and the challenges for their application to newborn screening programs.
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Costich JF, Durst AL. The Impact of the Affordable Care Act on Funding for Newborn Screening Services. Public Health Rep 2016; 131:160-6. [PMID: 26843682 DOI: 10.1177/003335491613100123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The Affordable Care Act requires most health plans to cover the federal Recommended Uniform Screening Panel of newborn screening (NBS) tests with no cost sharing. However, state NBS programs vary widely in both the number of mandated tests and their funding mechanisms, including a combination of state laboratory fees, third-party billing, and other federal and state funding. We assessed the potential impact of the Affordable Care Act coverage mandate on states' NBS funding. METHOD We performed an extensive review of the refereed literature, federal and state agency reports, relevant organizations' websites, and applicable state laws and regulations; interviewed 28 state and federal officials from August to December 2014; and then assessed the interview findings manually. RESULTS Although a majority of states had well-established systems for including laboratory-based NBS tests in bundled charges for newborn care, billing practices for critical congenital heart disease and newborn hearing tests were less uniform. Most commonly, birthing facilities either prepaid the costs of laboratory-based tests when acquiring the filter paper kits, or the facilities paid for the tests when the kits were submitted. Some states had separate arrangements for billing Medicaid, and smaller facilities sometimes contracted with hearing test vendors that billed families separately. CONCLUSION Although the Affordable Care Act coverage mandate may offset some state NBS funding for the screenings themselves, federal support is still required to assure access to the full range of NBS program services. Limiting reimbursement to the costs of screening tests alone would undermine the common practice of using screening charges to fund follow-up services counseling, and medical food or formula, particularly for low-income families.
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Affiliation(s)
- Julia F Costich
- University of Kentucky, Department of Health Policy and Management, Lexington, KY
| | - Andrea L Durst
- University of Pittsburgh, Department of Human Genetics, Pittsburgh, PA
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15
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Newborn screening for severe combined immune deficiency (technical and political aspects). Curr Opin Allergy Clin Immunol 2015; 15:539-46. [DOI: 10.1097/aci.0000000000000221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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. APPLIED HEALTH ECONOMICS AND 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] [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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Grosse SD. Showing Value in Newborn Screening: Challenges in Quantifying the Effectiveness and Cost-Effectiveness of Early Detection of Phenylketonuria and Cystic Fibrosis. Healthcare (Basel) 2015; 3:1133-57. [PMID: 26702401 PMCID: PMC4686149 DOI: 10.3390/healthcare3041133] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/05/2015] [Indexed: 01/24/2023] Open
Abstract
Decision makers sometimes request information on the cost savings, cost-effectiveness, or cost-benefit of public health programs. In practice, quantifying the health and economic benefits of population-level screening programs such as newborn screening (NBS) is challenging. It requires that one specify the frequencies of health outcomes and events, such as hospitalizations, for a cohort of children with a given condition under two different scenarios-with or without NBS. Such analyses also assume that everything else, including treatments, is the same between groups. Lack of comparable data for representative screened and unscreened cohorts that are exposed to the same treatments following diagnosis can result in either under- or over-statement of differences. Accordingly, the benefits of early detection may be understated or overstated. This paper illustrates these common problems through a review of past economic evaluations of screening for two historically significant conditions, phenylketonuria and cystic fibrosis. In both examples qualitative judgments about the value of prompt identification and early treatment to an affected child were more influential than specific numerical estimates of lives or costs saved.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; ; Tel.: +1-404-498-3074
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Serrano-Aguilar P, Castilla-Rodríguez I, Vallejo-Torres L, Valcárcel-Nazco C, García-Pérez L. Neonatal screening in Spain and cost–effectiveness. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1074072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gambin T, Jhangiani SN, Below JE, Campbell IM, Wiszniewski W, Muzny DM, Staples J, Morrison AC, Bainbridge MN, Penney S, McGuire AL, Gibbs RA, Lupski JR, Boerwinkle E. Secondary findings and carrier test frequencies in a large multiethnic sample. Genome Med 2015; 7:54. [PMID: 26195989 PMCID: PMC4507324 DOI: 10.1186/s13073-015-0171-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/06/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Besides its growing importance in clinical diagnostics and understanding the genetic basis of Mendelian and complex diseases, whole exome sequencing (WES) is a rich source of additional information of potential clinical utility for physicians, patients and their families. We analyzed the frequency and nature of single nucleotide variants (SNVs) considered secondary findings and recessive disease allele carrier status in the exomes of 8554 individuals from a large, randomly sampled cohort study and 2514 patients from a study of presumed Mendelian disease having undergone WES. METHODS We used the same sequencing platform and data processing pipeline to analyze all samples and characterized the distributions of reported pathogenic (ClinVar, Human Gene Mutation Database (HGMD)) and predicted deleterious variants in the pre-specified American College of Medical Genetics and Genomics (ACMG) secondary findings and recessive disease genes in different ethnic groups. RESULTS In the 56 ACMG secondary findings genes, the average number of predicted deleterious variants per individual was 0.74, and the mean number of ClinVar reported pathogenic variants was 0.06. We observed an average of 10 deleterious and 0.78 ClinVar reported pathogenic variants per individual in 1423 autosomal recessive disease genes. By repeatedly sampling pairs of exomes, 0.5 % of the randomly generated couples were at 25 % risk of having an affected offspring for an autosomal recessive disorder based on the ClinVar variants. CONCLUSIONS By investigating reported pathogenic and novel, predicted deleterious variants we estimated the lower and upper limits of the population fraction for which exome sequencing may reveal additional medically relevant information. We suggest that the observed wide range for the lower and upper limits of these frequency numbers will be gradually reduced due to improvement in classification databases and prediction algorithms.
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Affiliation(s)
- Tomasz Gambin
- />Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030 USA
- />Institute of Computer Science, Warsaw University of Technology, Warsaw, 00-665 Poland
| | - Shalini N. Jhangiani
- />The Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030 USA
| | - Jennifer E. Below
- />Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX 77030 USA
| | - Ian M. Campbell
- />Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030 USA
| | - Wojciech Wiszniewski
- />Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030 USA
| | - Donna M. Muzny
- />The Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030 USA
| | - Jeffrey Staples
- />Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX 77030 USA
| | - Alanna C. Morrison
- />Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX 77030 USA
| | - Matthew N. Bainbridge
- />The Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030 USA
| | - Samantha Penney
- />Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030 USA
- />Texas Children’s Hospital, Houston, TX 77030 USA
| | - Amy L. McGuire
- />The Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030 USA
- />Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030 USA
| | - Richard A. Gibbs
- />Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030 USA
- />The Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030 USA
| | - James R. Lupski
- />Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030 USA
- />Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030 USA
- />Texas Children’s Hospital, Houston, TX 77030 USA
| | - Eric Boerwinkle
- />The Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030 USA
- />Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX 77030 USA
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Kuhara T. [Present status of expanded newborn screening project for inborn errors of metabolism by tandem mass spectrometry]. Nihon Eiseigaku Zasshi 2014; 69:60-74. [PMID: 24476596 DOI: 10.1265/jjh.69.60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In Japan, screening for six diseases including four inborn errors of metabolism has been performed since 1977 for all neonates to prevent severe mental handicaps or death. A rapid screening procedure for analysis of several amino acids and acylcarnitines in blood spots by tandem mass spectrometry was developed by Millington DS et al. in the early 1990s. Although it is called expanded (or extended) newborn screening, the procedure is insufficiently sensitive to or specific for several diseases. Screening for all diseases that can be screened using this procedure is suggested to be cost-ineffective. Many European countries target only two diseases: medium-chain acyl-CoA dehydrogenase deficiency and phenylketonuria; their prevalence in Caucasian populations is very high, but some countries target more than twenty diseases and others an intermediate number. A pilot study targeting 22 diseases suggests that the combined incidence is one per 9,000 (0.01%) in Japan. This primary screening requires secondary screening to confirm the disease using urine, and either organic acids with solvent extraction or metabolome without fractionation are analyzed by gas chromatography-mass spectrometry. There is no need for primary or secondary screening tests to be performed at the same laboratory because the skills required are quite different. Understanding of the methodological problems of tandem mass screening and amelioration of variation and false positivity rate of this screening method among laboratories are critical to the success of the screening system in Japan. GC/MS-based urine metabolomics is expected to become one of the primary screening methodologies for neonates/infants who are already ill.
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