The economic returns to community and hospital screening programs for a genetic disease

Screening and prevention programs for genetic disorders have proliferated in the United States during the past decade. The National Genetics Act is currently facilitating their continued expansion. To achieve an efficient allocation of the resources available for screening and prevention, it is necessary to evaluate competing programs. We present a methodology designed for the evaluation of the economic impact of such programs and then illustrate it by using two models for Tay - Sachs disease prevention as a case study: (a) The Johns Hopkins School of Medicine, J.F. Kennedy Institute, Tay -Sachs Disease Community Screening and Prevention Program and (b) the Johns Hopkins Hospital weekly screening program. A total of 1,902 individuals were screened, 1,358 in the community program and 544 in the hospital program. The results indicate that both programs satisfied the economic criteria used. The benefit-cost ratio for the hospital screening program ranged from 1.6 to 3.2, while it ranged from 5.0 to 10.0 for the community based program. The difference in net economic returns to the community and hospital programs was primarily due to differences in program costs. The total direct and indirect costs per person screened in the community program was approximately one-half the equivalent figure for the hospital program.