Abstract
BackgroundFetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological abnormalities resulting from prenatal alcohol exposure. Though diagnosis may help improve patient outcomes, the diagnostic process can be costly. Subsequently, screening children suspected of FASD prior to diagnostic testing has been suggested, to avoid administering testing to children who are unlikely to receive a diagnosis. The present study set out to assess the cost-effectiveness of currently recommended FASD screening tools.MethodsThe screenings tools evaluated were chosen from Children’s Healthcare Canada’s National Screening Toolkit for Children and Youth Identified and Potentially Affected by FASD and include meconium testing of fatty acid ethyl esters (meconium testing) and the neurobehavioral screening tool (NST). An economic model was constructed to assess cost-effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of findings. Costs reflect 2017 Canadian dollars and the perspective is the public healthcare system.ResultsBoth screening tools evaluated resulted in reduced costs and fewer diagnosed years of life than a no screening strategy in which all children suspected of FASD receive diagnostic testing. The model predicts that screening newborns with meconium testing results in a reduced cost of $89,186 per 100 individuals screened and 38 fewer diagnosed years of life by age 18, corresponding to an incremental cost-effectiveness ratio (ICER) of $2359. Screening children with the NST resulted in a reduced cost of $183,895 per 100 individuals screened and 77 fewer diagnosed years of life by age 18, corresponding to an ICER of $2390.ConclusionFindings suggest that screening is associated with less use of healthcare recourses but also fewer years of life with an FASD diagnosis over a no screening strategy. Since diagnosis can be key to children receiving timely and appropriate health and educational services, cost-savings must be weighed against the fewer years of life with a diagnosis associated with screening.
Highlights
Fetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological abnormalities resulting from prenatal alcohol exposure
Screening children suspected of FASD prior to diagnostic testing has been suggested, as a method to avoid administering testing to children who are unlikely to receive diagnoses [13]
Cost-effectiveness analysis The model predicts that screening newborns with meconium testing results in a cost savings of $89,186 per 100 individuals screened and approximately 38 fewer years of life with an FASD diagnoses over the no screening strategy corresponding to an incremental cost-effectiveness ratio (ICER) of $2359
Summary
Fetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological abnormalities resulting from prenatal alcohol exposure. Screening children suspected of FASD prior to diagnostic testing has been suggested, to avoid administering testing to children who are unlikely to receive a diagnosis. The present study set out to assess the cost-effectiveness of currently recommended FASD screening tools. Standard care for FASD typically focuses on individualized symptoms management and evidence suggests that early intervention can be beneficial [9]. Screening children suspected of FASD prior to diagnostic testing has been suggested, as a method to avoid administering testing to children who are unlikely to receive diagnoses [13]. Screening is not without its limitations, as screening tools do not have perfect accuracy, screening may result in children who would test positive for FASD not being recommended to receive diagnostic testing
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