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The cost effectiveness of potential risk factors for developmental dysplasia of the hip within a national screening
Arwel T Poacher1, Joseph L J Froud2, Jessica Caterson3
1Trauma Department, University Hospital of Wales, Cardiff, UK.
Insights
Early detection of developmental dysplasia of the hip (DDH) is crucial. A novel screening program incorporating secondary risk factors like oligohydramnios and foot deformities proved more cost-effective than primary factors for identifying DDH.
Area of Science:
- Orthopedics
- Pediatric Health
- Public Health Screening
Background:
- Early detection of developmental dysplasia of the hip (DDH) improves conservative treatment outcomes.
- Current screening may miss cases, necessitating evaluation of novel approaches.
Purpose of the Study:
- To evaluate a new screening program for developmental dysplasia of the hip (DDH).
- To assess the inclusion of primary (breech presentation, family history) and secondary (oligohydramnios, foot deformities) risk factors.
- To determine the cost-effectiveness of these risk factors in predicting DDH.
Main Methods:
- A five-year prospective registry study of 27,731 live births.
- Screening for risk factors and clinical examinations at newborn and 6-8 week visits.
- Diagnosis of DDH using ultrasonography and Graf classification; analysis of risk factors, odds ratios, risk differences, and positive predictive value.
- Cost-effectiveness evaluation using NHS tariffs.
Main Results:
- Prevalence of DDH requiring treatment was 5/1,000 live births; missed presentation rate was 0.43/1000.
- Breech presentation, family history, oligohydramnios, and foot deformities were significantly associated with DDH (p < 0.0001).
- Secondary risk factors (oligohydramnios, foot deformities) were more cost-efficient predictors of DDH than primary factors, with lower cost-per-case detected.
Conclusions:
- The novel screening program incorporating secondary risk factors is clinically successful and more cost-efficient.
- Secondary risk factors demonstrate significant predictive value and should be considered for national DDH screening guidelines.
- Integrating these factors enhances early detection and resource allocation for DDH management.
Abstract:
Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate a novel screening programme that included both the primary risk factors of breech presentation and family history, and the secondary risk factors of oligohydramnios and foot deformities. A five-year prospective registry study investigating every live birth in the study's catchment area (n = 27,731), all of whom underwent screening for risk factors and examination at the newborn and six- to eight-week neonatal examination and review. DDH was diagnosed using ultrasonography and the Graf classification system, defined as grade IIb or above or rapidly regressing IIa disease (≥4o at four weeks follow-up). Multivariate odds ratios were calculated to establish significant association, and risk differences were calculated to provide quantifiable risk increase with DDH, positive predictive value was used as a measure of predictive efficacy. The cost-effectiveness of using these risk factors to predict DDH was evaluated using NHS tariffs (January 2021). The prevalence of DDH that required treatment within our population was 5/1,000 live births. The rate of missed presentation of DDH was 0.43/1000 live births. Breech position, family history, oligohydramnios, and foot deformities demonstrated significant association with DDH (p < 0.0001). The presence of breech presentation increased the risk of DDH by 1.69% (95% confidence interval (CI) 0.93% to 2.45%), family history by 3.57% (95% CI 2.06% to 5.09%), foot deformities by 8.95% (95% CI 4.81% to 13.1%), and oligohydramnios nby 11.6% (95 % CI 3.0% to 19.0%). Primary risk factors family history and breech presentation demonstrated an estimated cost-per-case detection of £6,276 and £11,409, respectively. Oligohydramnios and foot deformities demonstrated a cost-per-case detected less than the cost of primary risk factors of £2,260 and £2,670, respectively. The inclusion of secondary risk factors within a national screening programme was clinically successful as they were more cost and resource-efficient predictors of DDH than primary risk factors, suggesting they should be considered in the national guidance.
