Cost-Effectiveness of the Prenatal Detection of Congenital Heart Diseases: A Systematic Literature Review

Area of Science:

• Medical Economics
• Prenatal Diagnosis
• Congenital Heart Disease

Background:

• Congenital heart disease (CHD) is the most prevalent congenital condition globally, posing significant long-term health and economic burdens.
• Early detection of CHD is crucial for mitigating morbidity, mortality, and healthcare costs.
• Evaluating the cost-effectiveness of prenatal detection methods for CHD is essential.

Purpose of the Study:

• To systematically review and analyze economic evaluations of prenatal ultrasound screening for CHD.
• To assess reported cost-effectiveness results and methodological quality of included studies.
• To identify optimal strategies for prenatal CHD detection based on economic evaluations.

Main Methods:

• Systematic literature review (SLR) following PRISMA guidelines.
• Quantitative synthesis of incremental costs, effectiveness measures, and cost-effectiveness ratios.
• Methodological quality assessment using the 24 CHEERS criteria.

Main Results:

• Seven studies met inclusion criteria; most were cost-effectiveness analyses focusing on case detection.
• Screening with 4-chamber views by general practitioners/cardiologists was often dominant over 4-chamber plus outflow views by general practitioners.
• Fetal echocardiography was most effective but most expensive; 4-chamber and outflow view screening with specialist referral was the least expensive per defect detected.

Conclusions:

• Prenatal ultrasonography screening for CHD is consistently cost-effective, with effectiveness dependent on physician expertise.
• Most studies recommend obstetric ultrasonography screening without routine fetal echocardiography for CHD detection.
• Despite heterogeneity, findings support implementing cost-effective screening strategies for congenital heart diseases.