Cost-Effectiveness of Population-Based Genetic Hemochromatosis Screening

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Abstract
Objective: Evaluation of the costs of a population-based genetic hemochromatosis (HH) screening. Methods: We performed a decision tree analysis and subsequently quantified the screening and treatment costs and the effect on life expectancies. Assumptions were based on literature data and expert opinions. Results: Under the very conservative assumptions of a 10% penetrance, a carrier frequency of 10%, a mean age of onset of complications of 54 years, and a 90% compliance with treatment (phlebotomy), we calculated the cost to be 7.26 EUR per tested person versus 1.62 EUR per nontested person (1 EUR ≈ 1 USD). The life expectancies for a 25-year-old male are 48.99843 years (if not tested) versus 48.99970 years (if tested). Although increased life expectancy for the entire population as a result of screening is negligible, for the 1 in 4,000 men who could benefit from it, an average of 2,000 extra days will be gained. By dividing the difference of cost by the difference of life expectancy, we calculated the cost for one life year gained to be 4,441 EUR. Under less stringent conditions (higher penetrance, higher carrier frequency) the costs decrease substantially. Conclusion: Costs of population-based genetic HH screening are very acceptable compared to the costs of other health care measures. We conclude that genetic HH screening is feasible under economic aspects of health care.