Cost-effectiveness analysis of neonatal screening of critical congenital heart defects in China
Ruoyan Gai Tobe1, Gerard R Martin, Fuhai Li
1aDepartment of Health Policy, National Center for Child Health and Development, Tokyo, Japan bSchool of Public Health, Shandong University, Jinan, China cThe George Washington University School of Medicine and the Children's National Medical Center, Washington, DC dQilu Hospital of Shandong University, Jinan, China eThe Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital affiliated with the School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Insights
Clinical assessment is a cost-effective initial strategy for screening critical congenital heart disease (CCHD) in Chinese newborns. Combining pulse oximetry with clinical assessment offers better long-term health outcomes, especially with improved treatment access.
Area of Science:
- Public Health
- Health Economics
- Neonatal Screening
Background:
- Pulse oximetry is a cost-effective, noninvasive tool for early detection of critical congenital heart disease (CCHD) in newborns.
- Its simplicity and low cost make it beneficial for developing countries.
- Assessing CCHD screening cost-effectiveness in China is crucial for policy decisions.
Purpose of the Study:
- To evaluate the cost-effectiveness of different CCHD screening strategies in China.
- To inform clinical practice and health policy regarding neonatal screening.
Main Methods:
- A cohort model was developed to compare screening options: pulse oximetry alone, clinical assessment alone, and combined approach.
- Cost-effectiveness was measured by incremental cost per averted disability-adjusted life years (DALYs).
- Sensitivity analyses were conducted to ensure model robustness.
Main Results:
- Clinical assessment alone was the most cost-effective strategy (ICER: Int$5,728/DALY) compared to no screening.
- Pulse oximetry combined with clinical assessment yielded the best health outcomes.
- This combined approach showed superior expected values when treatment rates reached 57.5%.
Conclusions:
- Clinical assessment is a cost-effective preliminary choice for national neonatal CCHD screening in China.
- Pulse oximetry combined with clinical assessment is a valuable long-term strategy.
- Enhancing treatment accessibility is key to maximizing the benefits of CCHD screening.
Background:
Pulse oximetry screening is a highly accurate tool for the early detection of critical congenital heart disease (CCHD) in newborn infants. As the technique is simple, noninvasive, and inexpensive, it has potentially significant benefits for developing countries. The aim of this study is to provide information for future clinical and health policy decisions by assessing the cost-effectiveness of CCHD screening in China.
Methods And Findings:
We developed a cohort model to evaluate the cost-effectiveness of screening all Chinese newborns annually using 3 possible screening options compared to no intervention: pulse oximetry alone, clinical assessment alone, and pulse oximetry as an adjunct to clinical assessment. We calculated the incremental cost per averted disability-adjusted life years (DALYs) in 2015 international dollars to measure cost-effectiveness. One-way sensitivity analysis and multivariate probabilistic sensitivity analysis were performed to test the robustness of the model. Of the three screening options, we found that clinical assessment is the most cost-effective strategy compared to no intervention with an incremental cost-effectiveness ratio (ICER) of Int$5,728/DALY, while pulse oximetry plus clinical assessment with the highest ICER yielded the best health outcomes. Sensitivity analysis showed that when the treatment rate increased up to 57.5%, pulse oximetry plus clinical assessment showed the best expected values among the three screening options.
Conclusion:
In China, for neonatal screening for CCHD at the national level, clinical assessment was a very cost-effective preliminary choice and pulse oximetry plus clinical assessment was worth considering for the long term. Improvement in accessibility to treatment is crucial to expand the potential health benefits of screening.
