Costs were based on a health service perspective. This model was applied to ethnic composition data for district health authorities in the UK, based on their 1993 boundaries. Parameter values and their ranges were identified from published and unpublished sources, informed by expert opinion. It was assumed that districts would be willing to pay between 50,000 and 150,000 to offer an additional choice over the outcome of an affected fetus, based on an analysis of similar screening programmes, and between 10,000 and 50,000 to prevent an additional late diagnosis of sickle cell disease, based on review of other neonatal screening programmes and the estimated benefits of early diagnosis. Estimated lifetime treatment costs were used as benchmarks for affected live birth prevented ICERs in subsidiary analyses.
Results is a bullet.
The rationale for universal screening is therefore based on the presumption that it will result in a higher coverage among ethnic minority women and their children. Lowering the failure to screen rate in a selective programme is always more cost-effective than changing to a universal policy. Selective screening is highly cost-effective compared with no screening. If costs of ethnic ascertainment and pretest counselling are included, the case for universal compared with selective screening is slightly strengthened, but the case for selective screening compared with no screening is substantially weakened. 35,000- 145,000 per 10,000 antenatal population, and increased with prevalence.