This story reports on a study that analyzed the cost-effectiveness of testing newborns for a set of eight metabolic conditions. The fact that there is no uniform set of screening tests and each state varies in its screening requirements is a problem that should be addressed. However, there are some flaws with this story.
The story does not explain that this was a cost-effectiveness analysis, a simulation model of different screening strategies, not a randomized trial. No actual patients were studied, rather assumptions were made based on the existing literature. Furthermore, the story does not provide any quantification of benefits and does not mention any harms of screening. The most important harms would be related to false positive results, which could result in unnecessary treatment and undue anxiety for the parents.
The story mentions the cost of the screening tests (between $1.90 and $25 for each). However, these are very different from the cost-effectiveness results reported in the study, which were as high as $94,000 per quality-adjusted life year (QALY). This figure represents the actual societal costs of the screening test. Because so few newborns have the diseases in question and many positive results turn out to be false positive, the true costs to the healthcare system are greater than just the cost of the test itself.
The story repeatedly states that screening could save money, but it is not clear if this is the case or not. Most components of the multi-test screening strategy did dominate (i.e., less costly, more effective) the “no-test†strategy, however two did not – they were more effective, but also more costly.
The story appeared to rely too heavily on a press release from the Indiana School of Medicine. Not only are the same numbers reported in the story as the press release, but almost identical quotes are used as well. The story also only quotes the two principal investigators of the study – who are also both quoted in the press release. The story does not provide any additional perspectives.
For the study abstract in Pediatrics:
http://pediatrics.aappublications.org/cgi/content/abstract/117/5/S1/S287
For the Indiana University Press Release:
http://medicine.indiana.edu/news_releases/
The story mentions the cost of the screening tests (between $1.90 and $25 for each). However, these are very different from the cost-effectiveness results reported in the study, which were as high as $94,000 per quality-adjusted life year (QALY). This figure represents the actual societal costs of the screening test. Because so few newborns have the diseases in question and many positive results turn out to be false positive, the true costs to the healthcare system are greater than just the cost of the test itself.
The story repeatedly states that screening could save money, but it is not clear from the abstract if this is the case or not. Most components of the multi-test screening strategy did dominate (i.e., less costly, more effective) the “no-test” strategy, however two did not – they were more effective, but also more costly.
No quantification of benefits of screening for the set of eight disorders is provided. Although the story does state that the disorders are found in 3,000 infants nationally, this figure applies to the current screening strategy, not to the new proposed strategy. The story does not provide the reader with estimates of how many more disorders would be detected with this new strategy compared to the existing one.
The story does not mention any harms of screening. The most important harms would be related to false positive results, which could result in unnecessary treatment and undue anxiety for the parents
The story does not explain that this was a cost-effectiveness analysis, a simulation model of different screening strategies, not a randomized trial. No actual patients were studied, rather assumptions were made based on the existing literature.
By describing the prevalence as 1 out of 1000 children born every year, the story does not appear to engage in disease mongering.
The story only quotes the two principal investigators of the study – who are also both quoted in the press release. The story does not provide any additional perspectives.
The story does mention the alternatives – such as no testing or testing for some combination of other diseases.
The story does mention that screening for multiple diseases is available.
The story does not mention if bundling the screening tests through tandem mass spectrometry is new or not.
The story appeared to rely too heavily on a press release from the Indiana School of Medicine. Not only are the same numbers reported in the story as the press release, but almost identical quotes are used as well. The story only quotes the two principal investigators of the study – who are also both quoted in the press release. The story does not provide any additional perspectives.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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