Screening for sickle cell and thalassaemia in primary care: a cost-effectiveness study

Abstract

BackgroundHaemoglobinopathies, including sickle cell disease and thalassaemia (SCT), are inherited disorders of haemoglobin. Antenatal screening for SCT rarely occurs before 10 weeks of pregnancy. AimTo explore the cost-effectiveness of offering SCT screening in a primary care setting, during the pregnancy confirmation visit. Design and settingA model-based cost-effectiveness analysis of inner-city areas with a high proportion of residents from ethnic minority groups. MethodComparison was made of three SCT screening approaches: 'primary care parallel' (primary care screening with test offered to mother and father together); 'primary care sequential' (primary care screening with test offered to the mother and then the father only if the mother is a carrier); and 'midwife care' (sequential screening at the first midwife consultation). The model was populated with data from the SHIFT (Screening for Haemoglobinopathies In First Trimester) trial and other sources. ResultsCompared to midwife care, primary care sequential had a higher NHS cost of £34 000 per 10 000 pregnancies (95% confidence interval [CI] = £15 000 to £51 000) and an increase of 2623 women screened (95% CI: 1359 to 4495), giving a cost per additional woman screened by 10 weeks of £13. Primary care parallel was dominated by primary care sequential, with both higher costs and fewer women screened. ConclusionThe policy judgement is whether an earlier opportunity for informed reproductive choice has a value of at least £13. Further work is required to understand the value attached to earlier informed reproductive choices.

The organisation and delivery of health improvement in general practice and primary care: a scoping study

“…Four papers examined exercise and weight loss, 386,400,427,428 and there were two papers in each of the following topic areas: CVD, 298,429 NHS Health Checks, 149,150 and health checks for people with learning disabilities. 158,161 The other three papers examined sickle cell screening, 430 breast screening 210 and smoking cessation. 380 Generally there was little substantial evidence to make general conclusions about the cost-effectiveness of health improvement interventions in general practice.…”

The Regulation and Expression of Hepcidin in Carcinogenesis as a Result of Iron Overload Disorders: An Extended Literature Review

“…Bryan et al [74] however, has disregarded this theory, suggesting in hepatocellular carcinoma, a secondary molecule must be present in order to trigger the expression of hepcidin. One example, in particular, is thought to occur through the activation of STAT3 by the inflammatory cytokine IL-6.…”

“…One example, in particular, is thought to occur through the activation of STAT3 by the inflammatory cytokine IL-6. Throughout their study, Bryan et al [74] found that the binding of IL-6 to its receptor, lead to the activation of JAK2, which in turn, phosphorylates STAT3. STAT3 was then translocated to the nucleus and bound to its binding motif at -64/-72 within the promoter region of hepcidin.…”

“…STAT3 was then translocated to the nucleus and bound to its binding motif at -64/-72 within the promoter region of hepcidin. Thus, leading to the induction of hepcidin's transcription and production Bryan et al [74].…”

Commissioning maternity care: little room for manoeuvre?

“…Also in this month's journal, Bryan et al present the economic analysis of early screening for thalassaemia and haemoglobinopathies. 5 Previous papers from this study had established that threequarters of all women consulted for pregnancy before 10 weeks' gestation, but that fewer than 5% had received screening by that time. 6 Introducing two different models where screening was offered at the first consultation, and before the midwife booking consultation, increased the proportion screened by 10 weeks from 2% to 24% and 28%.…”