[Evaluation of the cost-effectiveness of school screening for hereditary hemoglobin abnormalities: prospective study in Bouches-du-Rhône. School screening for hemoglobinopathies]. / Evaluation coût-efficacité du dépistage scolaire des anomalies héréditaires de l'hémoglobine: une étude prospective dans les Bouches-du-Rhône. Dépistage scolaire des hémoglobinoses.

ABSTRACT

Screening in schools for heterozygote carriers of haemoglobinopathies traits has been carried out experimentally in southeast France ("Bouches du Rhône", the Marseille region) since 1977. The study compares, in cost-effectiveness terms, the screening strategy now followed with 27 alternative strategies in all the pupils (14-16 years). Although the frequency of heterozygote carriers in this school population as a whole is only 7.9% carriers for beta-thalassaemia gene and 2.5% carriers for HbS, prospective costs per diagnosis still seem reasonable from 1544 to 4997 French francs (1987) depending on the strategy, and 2099 to 7380 francs if beta-thalassaemia alone is screened. In comparison with the current screening strategy, cost-effectiveness ratios could be improved by using haemoglobin electrophoresis as a preselection test, or a blood count if beta-thalassaemia alone is screened. Further improvement of cost-effectiveness ratios could be obtained by limiting screening to ethnic groups most "at risk"; but such strategies raise ethical and acceptability issues.