Newborn screening programmes for cystic fibrosis should be adopted internationally

Newborn screening for cystic fibrosis saves on treatment costs and would offset the actual costs of the screening programme.

This new economic evidence suggests that universal newborn screening programmes for cystic fibrosis should be adopted internationally, according to an Article in this week's issue of The Lancet.

The study also showed that newborn cystic fibrosis screening reduced hospital admissions for invasive therapy.

Cystic fibrosis is a life-shortening hereditary lung disease, but treatments are available. In some regions newborn babies have been screened for cystic fibrosis for more than 25 years, and early diagnosis is associated with improvements in some clinical outcomes*. Furthermore, the clinical benefit of those screened as newborn babies is associated with a lower treatment burden compared with clinically diagnosed groups. Whether these potential cost savings attributed to reduced therapeutic requirements would offset the cost of a newborn screening programme had not previously been studied.

Cystic fibrosis screening hit the headlines in November 2006, when it was announced that UK Chancellor Gordon Brown's baby son Fraser had been diagnosed. Babies are routinely screened for the condition in Scotland (since 2003), Wales and Northern Ireland, but this is not yet the case for all areas of England, including London.

Dr Erika Sims (University of East Anglia, Norwich, UK) and colleagues from the University of Dundee, UK, used data from the UK cystic fibrosis database for 2002 to compare the treatment costs of 184 children aged 1–9 years who had cystic fibrosis that was identified by newborn screening with those of 950 children in the same age-group, who were identified after clinical presentation of the disease. Patients diagnosed by newborn screening cost significantly less to treat than those who were diagnosed clinically. Patients diagnosed on the basis of clinical presentation alone received therapy costing an estimated 60–400% more than patients diagnosed by newborn screening.

The authors conclude: "Newborn screening is associated with lower estimated treatment costs and reduced hospital admissions for invasive therapy, which suggests that indirect costs and disruption to family life will also be less. Furthermore, the potential cost savings to the yearly treatment budget could offset some, if not all, of the costs of a newborn screening service".

In an accompanying Comment, Bridget Wilcken and Kevin Gaskin (both of both the Children's Hospital at Westmead, and University of Sydney, NSW, Australia) state: "If clear clinical benefit does not always persuade governments to implement screening, cost benefits might. . .Some parts of the world—e.g. the middle east and possibly India—have a high frequency of cystic fibrosis, and screening might have potential in countries with a stable health-care system."