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Screening for congenital dislocation of the hip: an economic appraisal
Insights
Screening for congenital dislocation of the hip (CDH) in newborns is cost-effective. Early detection and conservative treatment of CDH are less expensive than surgical interventions for untreated cases.
Area of Science:
- Pediatric Orthopedics
- Health Economics
- Public Health Policy
Background:
- Congenital dislocation of the hip (CDH) requires timely diagnosis and intervention.
- The economic impact of screening versus no screening for CDH has not been fully elucidated in British Columbia.
Purpose of the Study:
- To conduct a cost-effectiveness analysis comparing direct screening costs for CDH with the treatment costs of undetected cases.
Main Methods:
- A cost-effectiveness analysis was performed in British Columbia.
- Direct costs of screening and conservative treatment were compared to costs of surgical hip reduction for missed cases.
Main Results:
- Screening for 6-15 CDH cases per 1000 infants was considerably less costly than treating 1.5 missed cases per 1000 without screening.
- Sensitivity analyses indicated that only unfavorable screening assumptions and optimistic no-screening assumptions narrowed the cost gap.
Conclusions:
- Screening for congenital dislocation of the hip is a cost-effective strategy in British Columbia.
- The findings support the implementation and continuation of CDH screening programs to reduce long-term healthcare costs.
Abstract:
The direct costs of screening for congenital dislocation of the hip (CDH) are compared with the treatment costs resulting from no screening in a cost-effectiveness analysis in British Columbia. Under certain conditions the costs associated with screening and subsequent conservative treatment for 6 to 15 positive cases of CDH/1000 liveborn infants were considerably lower than the costs of either open or closed reduction of the hip for 1.5 infants with CDH per 1000 infants not screened. When adjustments were made to the assumptions about screening costs, rates with which cases were missed and hospital treatment costs, only the assumptions thought to be overly unfavourable to screening and overly optimistic for no screening brought the costs of no screening within the likely range of costs of screening. Some specific and general implications of the cost-effectiveness of screening for CDH in British Columbia are discussed.