Prevention of Β Thalassemia in Northern Israel - A Cost-Benefit Analysis.

Abstract

Backgroundβ Thalassemia major is characterized by hemolytic anemia, ineffective erythropoiesis and hemosiderosis. About 4% of the world population carries a Thalassemia gene. Management includes blood transfusions and iron chelation. However, this treatment is costly, and population screening may be significantly more cost beneficial.PurposeThe purpose of the current study is to analyze the cost of running a prevention program for β Thalassemia in Israel and to compare it to the actual expenses incurred by treating Thalassemia patients.MethodsThree cost parameters were analyzed and compared: the prevention program, routine treatment of patients and treatment of complications. An estimation of the expenses needed to treat patients who present with complications was calculated based on our ongoing experience in treating deteriorating patients.Results and ConclusionsThe cost of preventing one affected newborn was $63,660 compared to $1,971,380 for treatment of a patient during 50 years (mean annual cost: $39,427). Thus, the prevention of 45 affected newborns over a ten year period represents a net saving of $88.5 million to the health budget. Even after deducting the cost of the prevention program ($413.795/year), the program still represents a benefit of $76 million over ten years. Each prevented case could pay the screening and prevention program for 4.6 years.

The α-Thalassemias

“…40 The benefits of accurate diagnosis of iron deficiency and other hemoglobinopathies -hemoglobin S and β-thalassemia in particular -should also be considered. Costbenefit analyses of β-thalassemia prevention programs in Quebec, 41 Iran, 42 Israel, 43,44 and the United Kingdom 45 have generally confirmed the overall benefits of such programs (i.e., the costs of prevention were lower than the costs of treatment), but the studies did not include α-thalassemia. In low-and middle-income countries, the implementation of such programs could benefit from existing infrastructures (e.g., ongoing screening programs for phenylketonuria or glucose-6-phosphate dehydrogenase deficiency) or could result in an overall improvement in access to health care for local communities.…”

Genetic Epidemiology and Preventive Healthcare in Multiethnic Societies: The Hemoglobinopathies

“…Koren et al . have recently calculated that the expenses for running a thalassemia prevention program in Northern Israel during one year (2011) was about 400,000 US $, while the cost of basic treatment of a single patient for an average life expectancy was about 2,000,000 US $ [28]. Other authors have commented that primary prevention of HBP is not only financially justifiable but it is also an act of mercy sparing suffering to potential patients and families [32].…”

Prenatal Diagnosis of Hemoglobinopathies: From Fetoscopy to Coelocentesis

“…Religious leaders may opposed abortion of severely affected children or consider it as an act of mercy while public health authorities may consider it a valid alternative to reduce human suffering and public health expenses. 110,111 In several Muslim countries abortion is permissible up to 120 days of gestation to save the life of the mother or to prevent a severely affected child, while, for example, in Morocco, a land with very high illegal abortions, the intervention is punished by law unless the mother's life is in danger. 112,113 Furthermore, people who have made a decision should be help and they should not be discriminated for their decision either terminating the pregnancy or giving birth to an affected child.…”