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Cost effectiveness of establishing a neonatal screening programme for phenylketonuria in Libya

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Abstract

Background

Inborn errors of metabolism (IEM) are a significant cause of morbidity and mortality in North Africa and the Middle East. With the evident success of neighbouring countries in initiating neonatal screening for IEM, the Libyan Authorities are now considering introducing neonatal screening for phenylketonuria (PKU) in Libya in the first instance, with the prospect of expanding the programme to cover other IEM in the future.

Objective

To estimate the cost effectiveness of neonatal screening for PKU compared with no neonatal screening in Libya.

Methods

A decision model was constructed to estimate the cost effectiveness of neonatal screening for PKU, from the perspective of Libyan society. Healthcare resource use and other input parameters were based on expert opinion.

Results

The expected discounted cost to Libyan society of screening over 15 years and managing ~ 374 patients with detected PKU over their lifetime was estimated to be $US213.6 (95% CI 211.9, 214.3) million (year 2007–8 values). The current expected discounted cost of managing these same PKU patients over their lifetime as a result of not screening was estimated to be $US321.2 (95% CI 318.0, 322.7) million. Hence, screening would save Libyan society $US107.6 (95% CI 105.5, 109.1) million over the lifetime of PKU patients and lead to an additional 6947 life-years (95% CI 6837, 7056). The expected cost per undiscounted life-year gained was estimated to be-$US15 500 (95% CI-16 600, 1100). There would be a 90% return on investment in the screening programme since society would gain $US1.9 for every $US1 invested. Probabilistic sensitivity analysis demonstrated that the screening programme has a 0.95 probability of being cost effective even at a willingness-to-pay threshold of $US4000 per life-year gained.

Conclusions

Within the model’s limitations, neonatal screening for PKU appears to offer Libyan society a strategy that is cost effective compared with no neonatal screening.

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Acknowledgements

The authors would like to thank the following people for their contributions:

Khadra Hospital, Tripoli: Dr H. Abedi, Neonatologist; Dr K. Honi, Neonatologist; Dr H. Sahli, Metabolic Specialist; Nurse J. Botha, Health Share.

Tripoli Children’s Hospital, Tripoli: Professor M. Dekna, General Paediatrician; Dr M. Kara, Neurologist; Dr K. El Rafifi, Metabolic Specialist; Dr Smeddah, Neonatologist.

Tripoli Medical Center, Tripoli: Professor M. Doggah, Metabolic Specialist; Professor F. Nafati, Neonatologist.

Zawia Hospital, Zawia City: Dr B. El-Jerbi, Endocrinologist; Dr D. Gremida, Metabolic Specialist; Dr M. Abuauba, Endocrinologist.

Dr A. Fatah Gabaj, Director, National Medical Research Center (NMRC), Zawia City; Mrs Hager, Manager of Tolitela Mental Health Institute, Tripoli; Dr A.W. Jaroud, Director of National Pharmaceutical and Medical Supply Company (NPMSCO), Tripoli; Mr A. Mahdi, Director of Mental Care Institutes within Tripoli area; Mr C. Bardakjian, Sales and Marketing Director, HVD Vertriebs GmbH (Perkin Elmer), Athens.

The authors would also like to thank the different Libyan-based couriers who provided relevant information pertaining to transportation of blood samples.

This study was sponsored financially by SHS International Ltd, Liverpool, UK and Nutricia Middle East & Africa, Dubai, UAE. Neither SHS International Ltd nor Nutricia had any input into the study design. Nor did they review the results or have any input into writing this manuscript. The authors have no other potential conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. CATALYST Health Economics Consultants Ltd, 34b High Street, Northwood, Middlesex, HA6 1BN, UK

    Erikas Sladkevicius &  Julian F. Guest

  2. Children’s Hospital, Sheffield, UK

    Rodney J. Pollitt

  3. Tripoli Medical Center, Tripoli, Libya

    Ali Mgadmi

  4. Postgraduate Medical School, University of Surrey, Guildford, Surrey, UK

    Julian F. Guest

Authors
  1. Erikas Sladkevicius
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  2. Rodney J. Pollitt
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  3. Ali Mgadmi
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  4. Julian F. Guest
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Correspondence to Julian F. Guest.

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Sladkevicius, E., Pollitt, R.J., Mgadmi, A. et al. Cost effectiveness of establishing a neonatal screening programme for phenylketonuria in Libya. Appl Health Econ Health Policy 8, 407–420 (2010). https://doi.org/10.2165/11535530-000000000-00000

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