CF screening costs.(Letters)(Letter to the Editor)

Dr. David R. Witt said that cystic fibrosis screening was cost effective, but the numbers just don't make sense ("Prenatal Screening Halves CF Births," Dec. 15, 2003, p. 1).

In the reported study, 56,000 patients were screened, 2,003 carriers were found, and 15 cases of severe CF were diagnosed antenatally; 9 of these 15 pregnancies were terminated. Dr. Witt estimated that the prevention of nine cases of severe CF saved $6.75 million, based on a lifetime medical cost of $750,000 per patient. Testing over the 4 years of the study cost $7.3 million, based on a cost of $130 per test.

Since the average life expectancy of someone with CF is about 30 years, the estimated lifetime cost translates to about $25,000 a year. Compare this with the testing cost of about $1.8 million a year in this study to detect three to four severe cases a year. These figures would have to be much worse if applied on a national basis, because Kaiser Permanente of Northern California is getting a great price on the CF screening test. My patients are charged closer to $400 per test. This comes to a cost of well over a $1 million to detect each case of severe CF.

It seems that the money spent on genetic screening for CF could cover the medical costs of patients with CF, with enough left over for research to cure the disease. I fear that someone is getting rich by providing screening tests and that our prenatal care dollars are being eroded as a result.

Laurent Nicolov, M.D.