Evaluation and cost-effectiveness analysis of prevention program of major thalassemia in Sistan-Balouchestan and Fars provinces.

While the prevalence of thalassemia carriers is 4-8% in Iran, it reaches to 10% in Sistan-Balouchestan and Fars Provinces. Regarding the high prevalence of the disease and different cultural, social, and economic situation in the mentioned provinces, we have attempted to calculate the marginal cost-effectiveness ratio through a decision analysis approach based upon the best evidences. Screening was included as part of existing mandatory premarital blood tests. The couples at risk (thalassemia minor) were offered information and genetic counseling for dissuation. This study is a summative external program evaluation. The required data were collected from Health Deputy of the Governor House, Civil Registry Organization, Governor House, and other related centers during a 4-year period from 1998 to 2002. Collected data and costs were placed in the decision tree and analyzed through average folding back method. The marriage dissuasion rate was 3.5% in carrier couples of Sistan-Balouchestan in 2000 and reached to 0.5% in 2002. It is while marriage dissuasion rate was 61.1% in 2000 and 48% in 2002 in Fars province. The incidence rate of major thalassemia was 150 per 100,000 live births in Sistan-Balouchestan in 1999 and increased to 180 per 100,000 live births in 2002. The rate was 54.5 per 100,000 live births in Fars in 1999 and decreased to 24.8% in 2002. Marginal cost-effectiveness ratio of the program reveals that prevention from birth of a thalassemia major child costs 36470.5$ in Sistan-Balouchestan and 1568.2$ in Fars. Although the thalassemia prevention program has been successful over the country, evaluation studies show major differences in the assessed provinces. Despite all activities for prevention of thalassemia and small increase in coverage index of the program in Sistan-Balouchestan in recent years, cost of prevention from birth of a major thalassemic child in the province is 30 times more than Fars. One of the main reasons of the difference is ineffective consultation in Sistan-Balouchestan. In this province, religious marriage is often performed before official registration. Consultation is a prerequisite before official registration. Many couples are visited in the consultation centers even after having a child.