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June 2016 (Volume 94)
Quarterly Article
Scott D. Grosse
John D. Thompson
Yao Ding
Michael Glass
Oct 14, 2026
September 2026
Back to The Milbank Quarterly
Policy Points:
Context: Economic evaluations can inform policy decisions on the expansion of newborn screening panels. This article documents the use of cost-benefit models in Washington State as part of the rule-making process that resulted in the implementation of screening for medium-chain acyl-CoA dehydrogenase (MCAD) deficiency and 4 other metabolic disorders in 2004, cystic fibrosis (CF) in 2006, 15 other metabolic disorders in 2008, and severe combined immune deficiency (SCID) in 2014.
Methods: We reviewed Washington State Department of Health internal reports and spreadsheet models of expected net societal benefit of adding disorders to the state newborn screening panel. We summarize the assumptions and findings for 2 models (MCAD and CF) and discuss them in relation to findings in the peer-reviewed literature.
Findings: The MCAD model projected a benefit-cost ratio of 3.4 to 1 based on assumptions of a 20.0 percentage point reduction in infant mortality and a 13.9 percentage point reduction in serious developmental disability. The CF model projected a benefit-cost ratio of 4.0-5.4 to 1 for a discount rate of 3%-4% and a plausible range of 1-2 percentage point reductions in deaths up to age 10 years.
Conclusions: The Washington State cost-benefit models of newborn screening were broadly consistent with peer-reviewed literature, and their findings of net benefit appear to be robust to uncertainty in parameters. Public health newborn screening programs can develop their own capacity to project expected costs and benefits of expansion of newborn screening panels, although it would be most efficient if this capacity were shared among programs.
Author(s): Scott D. Grosse, John D. Thompson, Yao Ding, and Michael Glass
Keywords: neonatal screening, economics, cost-benefit analysis, cystic fibrosis, MCAD deficiency
Read on Wiley Online Library
Volume 94, Issue 2 (pages 366–391) DOI: 10.1111/1468-0009.12196 Published in 2016