Budget impact analysis of the incorporation of creatine kinase in neonatal screening for Duchenne Muscular Dystrophy in the public health system of a Brazilian state.

Abstract

Objectives: To evaluate the budgetary consequences of adopting the creatine kinase test in neonatal screening for Duchenne Muscular Dystrophy in the state of Mato Grosso. Methods: A deterministic modeling was carried out for a time horizon of 5 years in Microsoft Excel®. The population of interest was delimited by exponential smoothing based on the historical series of male live births with previous testing of Sperman’C correlation and solver technique. The projected population was adjusted according to the percentage of acceptance of the intervention obtained in the field research. The intent-to-diagnose principle laid the groundwork for offering confirmatory tests. A multivariate sensitivity analysis was performed with the purpose of testing the robustness of the results, varying the parameters: deployment rate and costs
simultaneously. Three scenarios were considered, an optimistic one, a base scenario and a less optimistic one. Results: The eligible population was 27,165 male newborns/year. The total cost and the cost per detected case was R$ 265,927.53 and R$ 37,989.65/year, respectively. In the first year, the budget impact was R$ 79,783.61 considering an deployment rate of 30%; in the fifth year, it reached the amount of R$ 186,161.75 with an implementation
rate of 70%. Conclusion: The budgetary impact was relatively low, however, there may be variations depending on the assumptions made in the analysis. The findings of this study, added to other factors such as accuracy, acceptance and feasibility of implementing the test,
can cooperate with managers in the decision to adopt or not the screening.