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Updated: Jun 2, 2025
Murine Fetal Echocardiography
Published on: February 15, 2013
Screening for Structural Heart Defects: A Single-Center Retrospective Cost Analysis for Fetal Echocardiography in
David M Leone1,2, Benjamin Ittleman3, Kathryn Virk4
1Heart Institute, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, USA. David.leone@cchmc.org.
Insights
Fetal echocardiography (FE) for parents with congenital heart disease (CHD) is costly. Targeted screening for complex cases offers better value than universal screening for simple cases, especially with sensitive ultrasounds.
Area of Science:
- Cardiology
- Prenatal Diagnosis
- Health Economics
Background:
- Parents with congenital heart disease (pCHD) have an elevated risk (3-6%) of recurrence in offspring.
- Fetal echocardiography (FE) is recommended for pCHD to detect neonatal congenital heart disease (CHD).
- The cost-effectiveness of FE screening in pCHD requires evaluation.
Purpose of the Study:
- To assess the cost of fetal echocardiography (FE) for detecting neonatal congenital heart disease (CHD) in parents with pre-existing CHD (pCHD).
- To compare the cost-effectiveness of universal FE versus selective FE guided by screening anatomical ultrasound (SAU).
Main Methods:
- Retrospective cohort study of 419 pCHD cases from 12/2015 to 12/2022.
- Stratification of pCHD into simple (Class I) and complex (Class II/III) categories.
- Cost analysis comparing universal FE with selective FE post-SAU, calculating cost per detected case and number needed to screen (NNT).
Main Results:
- 14 postnatal CHD cases (3.8%) were detected in 371 analyzed pCHD cases.
- Recurrence rates were 1.9% for simple pCHD and 5.1% for complex pCHD.
- Universal FE cost per detected case was $267,157 (NNT=560) for simple CHD and $135,125 (NNT=288) for complex CHD.
Conclusions:
- CHD recurrence risk is higher in pCHD, especially complex cases.
- Universal FE for simple pCHD is less cost-effective than targeted screening for complex pCHD.
- Cost-effectiveness depends on SAU sensitivity; early detection improves outcomes.
Abstract:
Fetal echocardiography (FE) is recommended for parents with congenital heart disease (pCHD) due to a 3-6% recurrence risk of congenital heart disease (CHD). This study aimed to evaluate the cost of FE for detecting neonatal CHD in pCHD. FE data were collected between 12/2015 and 12/2022. Parents were stratified by CHD complexity: "simple" (class I) and "complex" (class II/III). Cost analysis compared universal FE with selective FE following a positive level II screening anatomical ultrasound (SAU). Primary outcomes included the cost and number needed to screen (NNT) to detect one case of neonatal CHD. Of 419 pCHD cases, 48 were analyzed separately due to additional FE indications. Among the remaining 371 cases (73% maternal, 27% paternal; mean maternal age: 31 years), 14 postnatal CHD cases were detected (3.8%). Recurrence rates were 1.9% for simple pCHD (n = 156) and 5.1% for complex pCHD (n = 215). Universal FE increased the cost of detecting neonatal CHD. The cost per detected case was $267,157 for simple CHD (NNT = 560) and $135,125 for complex CHD (NNT = 288). The lower sensitivity of SAU reduced the cost of universal FE. In this single-center cohort, the recurrence risk of CHD in pCHD is higher than in the general population, particularly in complex cases. Universal screening in simple pCHD is costlier with high-sensitivity SAU. Targeted screening in complex pCHD may offer a better cost-to-risk ratio, highlighting the need for early detection to improve outcomes. The cost effectiveness is dependent on local SAU sensitivity rates.
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