| Summary: | 博士 === 國立臺灣大學 === 醫療機構管理研究所 === 97 === Background. A National Thalassemia Screening Program was adopted in Taiwan in 1993. However, the program’s results and impact were not known. The purpose of this study was to examine the results and determine if the program in Taiwan was cost-saving from a healthcare services perspective.
Methods. Patients with β-thalassemia major born between 1994 and 2003 were recruited through the help of all thalassemia clinics in Taiwan. A structured questionnaire was designed to collect the reasons for affected births. The costs of healthcare services with and without the National Thalassemia Screening Program were compared. If total costs with the screening program were smaller than those without the screening program, the screening program was considered to be cost-saving. We adopted different assumptions regarding the key factors in the screening program to examine the marginal effects of these variables.
Results. There were 97 affected births from 1994 to 2003.These births resulted after informed choice (n=4), screening problems (n=83), and undetermined causes (n=10). Approximately 83% (5/6) of affected births in 2003 came from interracial marriages. Underestimation of the cases with β-thalassemia major was revealed when the data obtained from Bureau of Health Promotion were compared with those we collected. Only data after 1999 are reliable and are used for cost analysis. The Hardy-Weinberg equation was used to calculate the carrier frequency. The total costs of healthcare services with and without the screening program under a 4% annual discount rate were US$ 16,124,044 and US$ 9,442,337, respectively for 50 years of follow-up. The screening program seemed not cost-saving.
Conclusions. This report has identified several areas that might improve the thalassemia screening program, such as public education for both the public and general physicians, providing care of new female immigrants. The most important factor affecting the costsavings of the screening program was prevalence of and iron deficiency anemia (IDA) in pregnant women. In an area with high prevalence of α-, β-thalassemia, and IDA in pregnant women, excluding the male partners of pregnant women with IDA into screening would be helpful.
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