Single Sample Thalassemia Test Shows Promise in Malaysia

In Malaysia, the national thalassemia program checks students in two steps. The usual way, called protocol 1, asks kids to come back for more visits. About one in five drops out, especially in rural Sabah and Sarawak. A new idea, protocol 2, keeps one blood sample and runs three tests from it, so no extra trips are needed.

Researchers looked at 2018 records from 65,990 students in those two states. They ran a computer test 10,000 times, giving each cost and dropout rate a chance to vary. Costs were allowed to wiggle around with a 15% spread, and dropout chances followed a beta-binomial shape. They then asked, for each possible willingness to pay, how likely the new method would be worth it.

The average extra cost per extra carrier found matched the earlier simple calculation: about MYR 20.8 in Sabah and MYR 10.3 in Sarawak. The 95% credible ranges were tight – Sabah 18.7-23.2, Sarawak 9.2-11.5. If decision makers are ready to spend MYR 25-50 for each extra carrier, the new protocol is cost-effective more than 91% of the time in Sabah and almost always in Sarawak. Even when they assumed a worse dropout of 5% for the new method, the chance of being a good deal stayed at 70% or higher.

These numbers show that the single-sample approach works well across realistic situations. The lower cost-effectiveness in Sarawak hints that it could help close gaps where drop-out is higher. The authors stress that the MYR 10-50 range is just for exploring scenarios, not a set policy rule. They suggest trying a pilot study and doing a full health-tech review before deciding how to roll out the new screening.