Many of these diseases can be treated very effectively and a sensitive screening test was available for most of the diseases. Except for cystic fibrosis, there have been no randomised controlled trials of the overall effectiveness of neonatal screening. Despite the anxiety generated by the screening process, there is strong parental support for screening. The effects of diagnosis through screening on subsequent reproductive behaviour is less clear. Conflicts exist between current concepts and the traditional principles of screening.
Neonatal screen ing is also of value in diseases which present early but with non-specific symptoms.
Indeed, almost all of the diseases considered could merit neonatal screening. The majority of economic evaluations failed to incorporate the health benefits from screening, and therefore failed to address the value of the information which the screening programmes provided to parents. The marginal cost of changing from present technology to tandem MS would be approximately 0.60 per baby at a workload of 100,000 samples a year, and 0.87 at 50,000 samples per year. The ability to screen for a wider range of diseases would lead to the identification of some 20 additional cases per 100,000 infants screened, giving a laboratory cost per additional diagnosis of 3000 at an annual workload of 100,000 babies per year. This compares with average, approximate laboratory costs of 6000 for diagnosing a case of phenylketonuria and 4000 for congenital hypothyroidism, and costs including specimen collection of 27,000 and 15,000, respectively.