Review Reports

Round 1

Reviewer 1 Report

This is a well designed study before the implementation of thalassemia control.  As we know there are a number of factors that may affect the program of prevention depends on the location, religious, social engagement and legal issue in each country. It is wisely to study different approaches in the control program to identify the best strategy before implementation the program nationwide.

Author Response

We thank the reviewer for the valuable comments. The cultural, social implications will be well studied before the new policies will be implemented. This is specially relevant to TOP followed by PND in Sri Lanka, where though the technology is available, the legal system is still rigid. Wider social discussions about the topic has still not happened for the procedure to be widely accepted.

Reviewer 2 Report

This is a well written paper where 3 new Policy Options for preventing thalassemia in Sri Lanka have been presented and the most beneficial and cost effective one suggested for implementation. As data from other regional prevention programmes from Iran and UK have been used for some of the cost calculations, this may be mentioned as one of the limitations. Also, in Policy Option 3 why was cost of fetal sampling by amniocentesis taken rather than a first trimester approach like CVS? This may be clarified.

Author Response

Thank you for your valuable comments. The reason for not using CV sampling for PND, is that the foetal medicine specialists in Sri Lanka are at present more comfortable in doing the procedure of amniocentesis at 16 weeks, rather than doing the former.