Cost-Effectiveness Analysis of Prenatal Screening Program for Thalassemia Between Semi-accelerated Screening Step and Current Program

Main Article Content

Tham Laoarayawat
Naruemon Bamrungsawad
Piyameth Dilokthornsakul
Peerapon Wong
Nilawan Upakdee

Abstract

Background: Thalassemia is a genetic blood disorder with high incidence in Thailand. Its treatment includes blood transfusion and iron chelating therapy for life long that lead to high cost. Therefore, effective screening processes are required to prevent the newborn with thalassemia.


Objective: To determine the cost-effectiveness of prenatal screening program for thalassemia between a semi-accelerated screening program and the current program.


Methods: Decision tree model was developed under provider perspective. Cost, effectiveness and probabilities data were from literature review. One-way sensitivity analysis was performed to explore around inputs in the model.


Results: The expected costs of the semi-accelerated screening program and the current program were ฿609.29 and ฿462.44, respectively. The expected outcomes to detect a severe thalassemia in fetuses from the semi-accelerated program and the current program is 34 cases and 8 cases in 10 000 couples, respectively. Incremental cost-effectiveness ratio was ฿57 499.80 per case detected.


Conclusions: The expected costs of the semi-accelerated screening program was higher than the current programs, but the number of fetuses with thalassemia detected from the semi-accelerated screening program was more than the current programs.


 

Article Details

How to Cite
Laoarayawat, T., Bamrungsawad, N., Dilokthornsakul, P., Wong, P., & Upakdee, N. (2020). Cost-Effectiveness Analysis of Prenatal Screening Program for Thalassemia Between Semi-accelerated Screening Step and Current Program. Ramathibodi Medical Journal, 43(1), 13 - 23. https://doi.org/10.33165/rmj.2020.43.1.227046
Section
Original Articles

References

1. Torcharas K. Diagnosis of Thalassemia. RTA Med J. 2012;65(2):127-132.

2. Suwannakhon N, Pongsawatkul K, Seeratanachot T, et al. The shortcut strategy for beta thalassemia prevention. Hematol Rep. 2018;10(2):7530. doi:10.4081/hr.2018.7530.

3. Committee of laboratory manual for diagnosis of the thalassemias and abnormal hemoglobins. Laboratory Manual for Diagnosis of the Thalassemias and Abnormal Hemoglobins. 5th ed. Nonthaburi: Clinical Research Center, Department of Medical Science, Ministry of Public Health; 2013. https://nih.dmsc.moph.go.th/aboutus/media/Guideline_Book%201.pdf. Accessed February 9, 2020.

4. Thanomrat P, Sritippayawan S, Wannapira W, Boon-Eam O, Sanguansermsri T. Prevention and control program of severe thalassemia: Buddhachinaraj Hospital Phitsanulok. J Health Science. 2003;12(3):361-369.

5. Comptroller General’s Department. Rate of Public Health Service Fees for Use in Disbursement of Medical Expenses in Government Hospitals, Section 6 Blood Services and Blood Component Fees and Section 7 Diagnostic Fees for Medical and Pathological Techniques. Bangkok: Comptroller General’s Department, Ministry of Finance; 2017. https://www.hfocus.org/sites/default/files/files_upload/w_393_-baychii_1_baychii_2.pdf. Accessed February 9, 2020.

6. Health Administration Division, Office of the Permanent Secretary, Ministry of Public Health. Rate of Public Health Service Fees in Government Hospitals under Ministry of Public Health 2017. Nonthaburi: The Agricultural Cooperative Federation of Thailand; 2017. https://phdb.moph.go.th/main/upload/web_news_files/xwn4olw6kxcsscws4g.pdf. Accessed February 9, 2020.

7. Hematology Research Center. Genetic Counselling in Thalassemia Disease. Phitsanulok: Naresuan University Hospital, Faculty of Medicine, Naresuan University; 2015.

8. Riewpaiboon A. Standard Cost Lists for Health Technology Assessment. Nonthaburi: Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health; 2011. https://www.hitap.net/wp-content/uploads/2014/09/2011-05-20_standard_costs_book.pdf. Accessed February 9, 2020

9. Chareonkul P, Kraisin J. Prevention and control of thalassemia at Saraburi Regional Hospital. J Med Assoc Thai. 2004;8(1):8-15.

10. Sirichotiyakul S, Maneerat J, Sa-nguansermsri T, Dhananjayanonda P, Tongsong T. Sensitivity and specificity of mean corpuscular volume testing for screening for alpha-thalassemia-1 and beta-thalassemia traits. J Obstet Gynaecol Res. 2005;31(3):198-201. doi:10.1111/j.1447-0756.2005.00280.x

11. Trisakul N, Siripulsak P, Chuesupalobol W. Prevalence of thalassemia, hemoglobinopathy, at-risk couples and incidence of thalassemia major from the screening program, prenatal and postnatal diagnosis at Yasothorn Hospital. J Hematol Transfus Med. 2009;19(4):285-292.

12. Pranpanus S, Sirichotiyakul S, Srisupundit K, Tongsong T. Sensitivity and specificity of mean corpuscular volume (MCH): for screening alpha-thalassemia-1 trait and and beta-thalassemia trait. J Med Assoc Thai. 2009;92(6):739-743.

13. Sirichotiyakul S, Wanapirak C, Srisupundit K, Luewan S, Tongsong T. A comparison of the accuracy of the corpuscular fragility and mean corpuscular volume tests for the alpha-thalassemia 1 and beta-thalassemia traits. Int J Gynecol Obstet. 2009;107(1):26-29. doi:10.1016/j.ijgo.2009.05.012.

14. Sangnark P. Prevalence of thalassemia and hemoglobinopathies in pregnant women at Bangkrathum Hospital, Phitsanulok Province. Buddhachinaraj Med J. 2009;26(1):37-43.

15. Tongsong T, Charoenkwan P, Sirivatanapa P, et al. Effectiveness of the model for prenatal control of severe thalassemia. Prenat Diagn. 2013;33(5):477-483. doi:10.1002/pd.4095.

16. Jaovisidha A, Ajjimarkorn S, Panburana P, Somboonsub O, Herabutya Y, Rungsiprakarn R. Prevention and control of thalassemia in Ramathibodi Hospital, Thailand. Southeast Asian J Trop Med Public Health. 2000;31(3):561-565.

17. Suwannakan B, Cheypratoom P, Panthasri N, Sangkitporn S. RMSc 8 Udonthani laboratory network for supporting prevention and control of thalassemia: 7 years of experience. J Med Tech Phy Ther. 2015;27(1):37-49.

18. Wong P, Thanormrat P, Srithipayawan S, et al. Risk of a couple having a child with severe thalassemia syndrome, prevalence in lower northern Thailand. Southeast Asian J Trop Med Public Health. 2006;37(2):366-369.

19. Yamsri S, Sanchaisuriya K, Fucharoen G, Sae-ung N, Ratanasiri T, Fucharoen S. Prevention of severe thalassemia in northeast Thailand: 16 years of experience at a single university center. Prenat Diagn. 2010;30(6):540-546. doi:10.1002/pd.2514.

20. Wanthong S, Fucharoen G, Fucharoen S. Screening for prevention and control of severe thalassemia at Maung Saung Hospital, Roiet province: 6 years of experience. J Med Tech Phy Ther. 2012;24(1):64-76.

21. Sukrat B, Suwathanapisate P, Siritawee S, Poungthong T, Phupongpankul K. The prevalence of iron deficiency anemia in pregnant women in Nakhonsawan, Thailand. J Med Assoc Thai. 2010;93(7):765-770.

22. Sumrit C, Sae-ung N, Fucharoen S, Fucharoen G. Selection of a couple at risk of having fetus with hemoglobin Bart’s hydrops fetalis: 6 years of experience at Suratthani hospital. J Med Tech Phy Ther. 2014;26(1):17-25.

23. Tongsong T, Wanapirak C, Sirivatanapa P, et al. Prenatal control of severe thalassaemia: Chiang Mai Strategy. Prenat Diagn. 2000;20(3):229-234.

24. Torcharus K, Juntharaniyom M, Wuttiwong J, Panichkul P. Prenatal diagnosis of thalassemia and cost of laboratory screening in pregnant women at Pramongkutklao Hospital. RTA Med J. 2008;61(3):133-142.

25. Tuntaraworasilp K. Thalassemia screening in pregnant women and prenatal diagnosis at antenatal care clinic, Maharaj Nakornsrithamarat Hospital. Reg 11 Med J. 2015;29(2):227-232.

26. Ratanasiri T, Charoenthong C, Komwilaisak R, et al. Prenatal prevention for severe thalassemia disease at Srinagarind Hospital. J Med Assoc Thai. 2006;89(suppl 4):S87-S93.

27. Tangvarasittichai O, Poonanan N, Tangvarasittichai S. Using red cell indices and reticulocyte parameters for carrier screening of various thalassemia syndromes. Indian J Clin Biochem. 2017;32(1):61-67. doi:10.1007/s12291-016-0574-9.

28. Nillakupt K, Nathalang O, Arnutti P, et al. Prevalence and hematological parameters of thalassemia in Tha Kradarn Districts Chachoengsao Province, Thailand. J Med Assoc Thai. 2012;95(suppl 5):S124-S132.

29. Kor-anantakul O, Suwanrath C, Leetanaporn R, Suntharasaj T, Liabsuetrakul T, Rattanaprueksachart R. Prenatal diagnosis of thalassemia in Songklanagarind Hospital in Southern Thailand. Southeast Asian J Trop Med Public Health. 1998;29(4):795-800.

30. Sananpanichkul P. 10-year analysis of the strategic plan for prevention and control of thalassemia in Prapokklao Hospital. J Prapokklao Hosp Clin Med Educat Center. 2011; 28(4):214-222.

31. Prayongratana K, Polprasert C, Raungrongmorakot K, Tatone K, Santiwatanakul S. Low cost combination of DCIP and MCV was better than that of DCIP and OF in the screening for hemoglobin E. J Med Assoc Thai. 2008;91(10):1499-1504.

32. Department of Medical Sciences, Ministry of Public Health. Press release: 12,000 New Thai Children with Thalassemia. https://www.dmsc.moph.go.th/dmscnew_old/news_detail.php?cid=1&id=1263#. Published March 9, 2016. Accessed February 9, 2020.

33. Tienthavorn V, Pattanapongsthorn J, Charoensak S, Sae-Tung R, Charoenkwan P, Sanguansermsri T. Prevalence of thalassemia carriers in Thailand. Thai J Hematol Transf Med. 2006;16(4):307-312.

34. Bureau of Reproductive Health, Ministry of Public Health. Thailand Reproductive Health Database: Total Number of Births. https://rhdata.anamai.moph.go.th/index.php/population/population17. Accessed February 9, 2020.

35. Bureau of Medical Technical and Academic Affair, Department of Medical Services, Ministry of Public Health. Guidelines for the Care of Thalassemia Patients in General Practice. Bangkok: WVO Officer of Printing Mill; 2017. https://www.biogenetech.co.th/wp-content/uploads/2018/01/Guidelines-for-thalassemia-care.pdf. Accessed February 9, 2020.