Abstract
The prevalence of thalassemia is found in approximately 1% of the population about 30-40% of carriers of thalassemia, it is possible to estimate that 5,125 new cases of severe thalassemia in every 1 million new born babies in Thailand. The severity of this disease is that the fetus dies while in the womb or dies within hours of birth, or if the fetus does not die, will incur the burden of direct and indirect care costs including delivery. As a result, the quality of life of patients and caregivers decreases. Currently, the National Health Security Office (NHSO) has set the rate of reimbursement for the screening and diagnosis of thalassemia in pregnant women by being included in the health benefit package. However, this compensation rate does not cover all screening costs, including hemoglobin (Hb) typing and deoxyribonucleic acid (DNA) analysis, which are considered sensitive techniques. and high specificity to screening. For this reason, couples are burdened with additional screening costs as well as the waiting time for screening and diagnosis results. Moreover, the frequency of screening follow-up and the ability to access services that are only available in large hospitals. It may be a factor contributing to a decrease in the rate of visits to screening and diagnosis of thalassemia. This study was an economic evaluation by using a cost-benefit analysis through the decision-tree model. The aim of this study was to analyze the costs and benefits of married couples from a social perspective if couples at risk were given genetic testing to diagnose thalassemia. Also, Thailand’s budget impact was determined. From the cost evaluation results, it was found that genetic testing for diagnosing thalassemia in married couples according to the Thai standard guidelines is economically cost-effective. The cost savings was 23,785 THB per prevention of a thalassemia case, and the benefit-to-cost ratio was 5.38 per 1 proportion. However, the disadvantage of Thailand's practice of screening for thalassemia carriers in pregnant women and their spouses is that the process after a pregnant woman is screened by MCV/MCH and DCIP techniques and shows positive results that we have to follow up with the husband at risk to come for an examination If there is a risk, it will continue to be examined with Hb typing technique. In case, reducing the screening process to be able to perform Hb typing immediately if a pregnant woman is at risk without waiting for results from her husband. A cost savings of 6,622 THB for the prevention of a thalassemia case when compared to the standard screening guidelines of Thailand. For the results of the budget impact analysis, it was found that there will be an increase in budget burden equal to 36 million baht per year. Therefore, from the results of the study, there are policy recommendations as follows: 1. The Royal College of Obstetricians and Gynecologists of Thailand should consider revising their screening and diagnostic guidelines, suggesting that after a pregnant woman has tested positive for MCV/MCH and DCIP, Hb typing should be screened immediately without the need to wait results from husband and after Hb typing is positive, she should be suggested to genetic test if it is unable to catch up her husband for reducing waiting time and screening process. Moreover, it would increase response rate whole diagnosis. 2. The National Health Security Office (NHSO) should manage the budget to cover both screening and diagnosis of thalassemia among pregnant women and at-risk spouses. 3. The quality of private laboratory testing by the Department of Medical Sciences should be carried out in order to increase the Hb typing and genetic testing services in order to increase the accessibility of all pregnant women and husbands. 4. There should be a systematic record of the results of screening and diagnosis, such as a health link system to be used as information for pregnant women and their husbands in the event of more than one pregnancy or transfer of medical rights. Subsequently, the screening data is not lost and the cost of screening and re-diagnosis is reduced. 5. Policy and control for new cases of thalassemia should be communicated, especially in couples planning pregnancy and general population.
