A Markov model to analyze cost-effectiveness of screening for severe combined immunodeficiency (SCID) |
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| Authors: | Chan Kee Davis Joie Pai Sung-Yun Bonilla Francisco A Puck Jennifer M Apkon Michael |
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| Affiliation: | aDepartment of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA;bDepartment of Epidemiology, School of Public Health, Boston University, Boston, MA USA;cNational Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA;dDepartment of Pediatrics, Harvard Medical School, Boston, MA, USA;eDepartment of Medicine, Division of Hematology, Children's Hospital, Boston, MA, USA;fDepartment of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA;gDepartment of Medicine, Division of Immunology, Childern’s Hospital, Boston, MA, USA;hDepartment of Pediatrics, School of Medicine, University of California San Francisco, CA, USA;iUniversity of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA;jDepartment of Anesthesiology and Critical Care, University of Pennsylvania, PA, USA;kChildren's Hospital of Philadelphia, PA, USA |
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| Abstract: | ![]()
ObjectiveTo evaluate the cost-effectiveness of universal neonatal screening for T cell lymphocytopenia in enhancing quality of life and life expectancy for children with severe combined immunodeficiency (SCID).MethodsDecision trees were created and analyzed to estimate the cost, life years, and quality adjusted life years (QALYs) across a population when universal screening for lack of T cells is used to detect SCID, as implemented in five states, compared to detection based on recognizing symptoms and signs of disease. Terminal values of each tree limb were derived through Markov models simulating the natural history of three cohorts: unaffected subjects; those diagnosed with SCID as neonates (early diagnosis); and those diagnosed after becoming symptomatic and arousing clinical suspicion (late diagnosis). Models considered the costs of screening and of care including hematopoietic cell transplantation for affected individuals. Key decision variables were derived from the literature and from a survey of families with children affected by SCID, which was used to describe the clinical history and healthcare utilization for affected subjects. Sensitivity analyses were conducted to explore the influence of these decision variables.ResultsOver a 70-year time horizon, the average cost per infant was $8.89 without screening and $14.33 with universal screening. The model predicted that universal screening in the U.S. would cost approximately $22.4 million/year with a gain of 880 life years and 802 QALYs. Sensitivity analyses showed that screening test specificity and disease incidence were critical driving forces affecting the incremental cost-effectiveness ratio (ICER). Assuming a SCID incidence of 1/75,000 births and test specificity and sensitivity each at 0.99, screening remained cost-effective up to a maximum cost of $15 per infant screened.ConclusionAt our current estimated screening cost of $4.22/infant, universal screening for SCID would be a cost effective means to improve quality and duration of life for children with SCID. |
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| Keywords: | Severe combined immunodeficiency (SCID) Newborn screening Cost-effectiveness Markov models T-cell receptor excision circle (TREC) Hematopoietic cell transplant |
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