The costs of late detection of developmental dysplasia of the hip
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Timothy Woodacre1, A Dhadwal, T Ball
1Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK, timwoodacre@yahoo.co.uk.
Insights
Early detection of infant hip dysplasia significantly reduces treatment costs. Late diagnosis increases complexity and leads to a sevenfold rise in treatment expenses, highlighting the need for improved early intervention strategies.
Area of Science:
- Pediatric Orthopedics
- Health Economics
- Medical Screening
Background:
- Developmental dysplasia of the hip (DDH) screening is debated for economic viability.
- Early detection and treatment are crucial for optimal outcomes in infant hip conditions.
Purpose of the Study:
- To evaluate the economic impact of screening for developmental dysplasia of the hip in infants.
- To determine treatment complexity and costs associated with DDH detection and management based on age at presentation and treatment modality.
Main Methods:
- Prospective study of 36,960 live births from 1998-2008.
- Utilized universal clinical screening and selective ultrasound screening for infants.
- Conducted a detailed cost analysis of disease detection and hospital treatment.
Main Results:
- 179 infants (4.8/1,000) presented with hip dysplasia.
- Late presenters (>3 months) incurred costs of £4,352/child, requiring surgery.
- Early presenters (<3 months) managed with Pavlik harness cost £601/child; those failing treatment incurred higher costs (£7,052/child).
Conclusions:
- Late detection of DDH significantly increases treatment complexity and costs.
- Early detection and successful Pavlik harness treatment are highly cost-effective.
- Improved strategies are needed for the 10% of early presenters who fail Pavlik harness treatment, requiring more complex interventions.
Purpose:
Debate currently exists regarding the economic viability for screening for developmental dysplasia of the hip in infants.
Methods:
A prospective study of infant hip dysplasia over the period of 1998-2008 (36,960 live births) was performed to determine treatment complexity and associated costs of disease detection and hospital treatment, related to the age at presentation and treatment modality. The involved screening programme utilised universal clinical screening of all infants and selective ultrasound screening of at-risk infants.
Results:
One hundred and seventy-nine infants (4.8/1,000) presented with hip dysplasia. Thirty-four infants presented late (> 3 months of age) and required closed or open reduction. One hundred and forty-five infants presented at < 3 months of age, 14 of whom failed early Pavlik harness treatment. A detailed cost analysis revealed: 131 early presenters with successful management in a Pavlik harness at a cost of £601/child; 34 late presenters who required surgery (36 hips, 19 closed/17 open reductions, one revision procedure) at a cost of £4,352/child; and 14 early presenters with failed management in a Pavlik harness requiring more protracted surgery (18 hips, four closed/14 open reductions, seven revision procedures) at a cost of £7,052/child.
Conclusions:
Late detection causes increased treatment complexity and a sevenfold increase in the short-term costs of treatment, compared to early detection and successful management in a Pavlik harness.
Discussion:
Improved strategies are needed for the 10 % of early presenting infants who fail Pavlik harness treatment and require the most complex and costly interventions.
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