Document Type : Original Article
Authors
1
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
2
Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
3
Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
4
Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
5
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Abstract
Background
Thalassaemia is a genetic blood disorder endemic in Thailand. Management of severe thalassaemia utilises significant resources posing a substantial socio-economic burden; thus, prevention has been identified as a more sustainable approach to address thalassaemia. This study evaluated the cost-effectiveness and budget impact of various thalassaemia screening strategies in Thailand, including both pre-conception and post-conception approaches.
Methods
A cost-effectiveness analysis (CEA), from the Thai healthcare payer’s perspective, was conducted using decision analytic modelling. Decision trees were used to estimate the incremental screening cost per severe thalassaemia birth averted for four main screening strategies compared to “no screening”: post-conception screening (Strategy 1), pre-conception screening with targeted deoxyribonucleic acid (DNA) analysis (Strategy 2), pre-conception screening with universal DNA analysis (Strategy 3), and a combination of pre-conception and post-conception screening (Strategy 4). The cost-effectiveness threshold (CET) used was the lifetime cost of managing severe thalassaemia in Thailand. The annual budget impact of the upfront costs of implementing these strategies was also estimated.
Results
Strategies 1, 2, and 4 were cost-saving compared to the threshold of the average lifetime cost of managing severe thalassaemia in Thailand, $21,017. Strategy 4 had the lowest screening cost of $6773 [$4522–$10 066] per severe thalassaemia birth averted. Strategy 2 cost $8977 [$5689–$13 956] per severe thalassaemia birth averted, and Strategy 1 cost $10 474 [$7121–$15 734] per severe thalassaemia birth averted. In contrast, Strategy 3 cost $57 692 [$33 240–$96 123] per severe thalassaemia birth averted and is not cost-saving. The annual budget impact of the upfront costs of implementing thalassaemia screening ranged from $1.30 million to $288.93 million, depending on the strategy adopted and uptake rates.
Conclusion
Post-conception thalassaemia screening is cost-saving in Thailand. Combining pre-conception and postconception screening strategies may offer even better value for money in the Thai context, but with a higher upfront cost of implementation.
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