Solubility tests and the peripheral blood film method for screening for sickle cell disease: A cost benefit analysis

Abstract

Objective. To determine the cost benefit of screening for sickle-cell disease among infants at district health centres in Uganda using sickling, solubility tests and the peripheral blood film method.
Methods. Pilot screening services were established at district health centres. Cost benefit analysis (CBA) was performed in four scenarios: A1 – where there are no sickle-cell screening services at district health centres and all children are referred either to Mulago tertiary referral hospital or A2 – a regional hospital for haemoglobin (Hb) electrophoresis; B1 – when there are screening services at district health centres, only positive samples are taken either to Mulago Hospital or B2 – the regional hospital for confirmation using haemoglobin electrophoresis. Calculations were done in Uganda shillings (USh).
Results. Initial operational costs were high for all scenarios but variably reduced in the subsequent years. Scenarios A1 and A2 were very sensitive compared with B1 and B2. Scenario A1 had the highest screening costs in the subsequent years, costing over 62 000 USh per test in both eastern and western Uganda. Scenario B2 was sensitive and cheaper when using the sickling test, but was expensive and insensitive when using the solubility test and more insensitive though cheaper when using the peripheral blood film method.
Conclusions and recommendation. Screening children in Mulago hospital using haemoglobin electrophoresis (A1) was very expensive although it was sensitive. Screening the children at four health centres using the sickling method and confirming positive samples at a regional hospital (B2) was both cheap and sensitive and is therefore recommended.