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April 1995

Is Universal Neonatal Hemoglobinopathy Screening Cost-effective?-Reply

Author Affiliations

Division of Policy and Ethics Duke University-University of North Carolina Comprehensive Sickle Cell Center Box 90290 Duke University Durham, NC 27708

Arch Pediatr Adolesc Med. 1995;149(4):466-467. doi:10.1001/archpedi.1995.02170160120023

Bergman, citing our social-cost analysis of universal neonatal hemoglobinopathy screening,1 objects that we did not account for all costs and benefits, for all risks and rewards. He is correct, in a way.

Cost-benefit enthusiasts would attempt a quasicomprehensive accounting, presenting as scientific whatever conclusion their initial assumptions, methodological simplifications, and final sensitivity adjustments left them. Such applications of the social to the natural sciences generate articles that range from the blandly predictable to the genuinely enlightening to the falsely provocative. Some uncover instructive ironies; some locate sensible compromises; others do neither.

We worked in full awareness of the problems to which Bergman justifiably has directed the attention of the Archives' readers; it was with these and other problems in mind that we chose a "shadow-pricing" mechanism for our cost-benefit commentary, which is really a comparison of two cost-effectiveness ratios. There is ultimately no satisfactory way to compute