Screening in schools for heterozygote carriers of haemoglobinopathies traits has been carried out experimentally in southeast France ("Bouches du Rhône", the Marseille region) since 1977. The study compares, in cost-effectiveness terms, the screening strategy now followed with 27 alternative strategies in all the pupils (14-16 years). Although the frequency of heterozygote carriers in this school population as a whole is only 7.9% carriers for beta-thalassaemia gene and 2.5% carriers for HbS, prospective costs per diagnosis still seem reasonable: from 1544 to 4997 French francs (1987) depending on the strategy, and 2099 to 7380 francs if beta-thalassaemia alone is screened. In comparison with the current screening strategy, cost-effectiveness ratios could be improved by using haemoglobin electrophoresis as a preselection test, or a blood count if beta-thalassaemia alone is screened. Further improvement of cost-effectiveness ratios could be obtained by limiting screening to ethnic groups most "at risk"; but such strategies raise ethical and acceptability issues.
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