Cost-effectiveness analysis of prenatal testing and outcomes for sickle cell disease and thalassemia in India

To evaluate the cost-effectiveness of prenatal screening for prevalent sickle cell anemia and thalassemia in the Indian healthcare system. This study presents an economic evaluation of prenatal screening for prevalent hemoglobinopathies using a decision-analytic tree model from a health system perspective. Additionally, the analysis compares the costs, effectiveness, and benefits of implementing prenatal screening against the alternative scenario of an affected couple giving birth to a child with a hemoglobinopathy. Screening for prevalent hemoglobinopathies is economically viable, with costs below India’s per capita GDP. To prevent a single hemoglobinopathy-affected birth, approximately 187 women must undergo screening, incurring an expenditure of ₹1.89 lakh per case averted. This intervention can potentially offset hemoglobinopathy patients' substantial lifetime treatment costs, estimated to be between ₹20 - ₹50 lakh on average. The analysis reveals high sensitivity to baseline disease prevalence. The screening process involves initial carrier identification using the HPLC method for both partners, followed by a confirmatory diagnostic. The estimated cost per hemoglobinopathy-affected birth prevented through this strategy is approximately US$2,150. Prenatal hemoglobinopathy screening offers a cost-effective and transformative strategy to reduce the burden of inherited disorders in India.