Cost-effectiveness of alternative screening strategies for developmental dysplasia of the hip
K. Rosendahl, T. Markestad, R. T. Lie, E. Sudmann and J. T. Geitung
Department of Pediatric Radiology, University Hospital, Bergen, Norway.
OBJECTIVE: To compare the cost-effectiveness of adding either a general or
a selective ultrasound screening program to the routine clinical
examination for developmental dysplasia of the hip (DDH) with use of the
data from a large, randomized study of 11,925 newborns. METHODS: Our
previous study comparing the clinical outcomes of three strategies for
screening infants for DDH suggested (but results were not statistically
significant) that general ultrasound screening resulted in fewer children
requiring hospitalization and surgery for DDH than did a strategy based on
ultrasound screening of the 11.8% of infants considered to be at increased
risk of DDH or one with no ultrasound screening. General ultrasound
screening led to early splinting of 3.4% of the newborns compared with 2.0%
for the selectively screened group and 1.8% for the group not receiving
ultrasound screening. Using these data, we decided on sequences and
intervals of diagnostic and therapeutic actions considered to be sufficient
for each regimen. We applied estimates of the costs of screening, treatment
of DDH discovered early and late, and follow-up examinations to arrive at
total program costs for each strategy. RESULTS: Total program costs were
similar for each of the three screening strategies (costs varied by <
5%). However, treatment of late cases accounted for only 22% of total costs
in the group undergoing general screening vs 65% in the two latter groups.
The cost estimates were sensitive to several variables. Application of the
data to a hypothetical ultrasound program in which all girls and only boys
at increased risk for DDH underwent an ultrasound examination showed
substantially reduced total program costs. CONCLUSIONS: Application of
costs from other centers to our data regarding frequency of clinical
outcomes may yield different comparative program costs. If the findings of
our clinical study can be generalized to other centers, a strategy of
screening all girls and boys with risk factors for DDH may be the most
cost-effective approach.
