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Comparing the clinical and economic effects of clinical examination, pulse oximetry, and echocardiography in newborn screening for congenital heart defects: A probabilistic cost-effectiveness model and value of information analysis

Published online by Cambridge University Press:  01 April 2007

Ingolf Griebsch ,
Rachel L. Knowles ,
Jacqueline Brown ,
Catherine Bull ,
Christopher Wren  and
Carol A. Dezateux
Ingolf Griebsch
Affiliation:
University of Bristol
Rachel L. Knowles
Affiliation:
UCL Institute of Child Health
Jacqueline Brown
Affiliation:
University of Bristol
Catherine Bull
Affiliation:
Great Ormond Street Hospital for Children
Christopher Wren
Affiliation:
Freemann Hospital
Carol A. Dezateux
Affiliation:
UCL Institute of Child Health
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Abstract

Objectives: Congenital heart defects (CHD) are an important cause of death and morbidity in early childhood, but the effectiveness of alternative newborn screening strategies in preventing the collapse or death—before diagnosis—of infants with treatable but life-threatening defects is uncertain. We assessed their effectiveness and efficiency to inform policy and research priorities.

Methods: We compared the effectiveness of clinical examination alone and clinical examination with either pulse oximetry or screening echocardiography in making a timely diagnosis of life-threatening CHD or in diagnosing clinically significant CHD. We contrasted their cost-effectiveness, using a decision-analytic model based on 100,000 live births, and assessed future research priorities using value of information analysis.

Results: Clinical examination alone, pulse oximetry, and screening echocardiography achieved 34.0, 70.6, and 71.3 timely diagnoses per 100,000 live births, respectively. This finding represents an additional cost per additional timely diagnosis of £4,894 and £4,496,666 for pulse oximetry and for screening echocardiography. The equivalent costs for clinically significant CHD are £1,489 and £36,013, respectively. Key determinants of cost-effectiveness are detection rates and screening test costs. The false-positive rate is very high with screening echocardiography (5.4 percent), but lower with pulse oximetry (1.3 percent) or clinical examination alone (.5 percent).

Conclusions: Adding pulse oximetry to clinical examination is likely to be a cost-effective newborn screening strategy for CHD, but further research is required before this policy can be recommended. Screening echocardiography is unlikely to be cost-effective, unless the detection of all clinically significant CHD is considered beneficial and a 5 percent false-positive rate acceptable.

Keywords

Newborn screeningCongenital heart defectsCost-effectivenessDecision-analytic modelValue of information analysis
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 2 , April 2007 , pp. 192 - 204
Copyright
Copyright © Cambridge University Press 2007

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