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Cost-benefit evaluation of systematic radiological diagnosis of congenital dislocated hip
Insights
Radiological mass screening for congenital dislocated hip in infants at 3-4 months offers a significant cost-benefit advantage over later detection. Early diagnosis via X-ray screening minimizes treatment costs and radiation exposure.
Area of Science:
- Pediatric radiology
- Public health screening
- Medical economics
Background:
- Congenital dislocated hip (CDH) diagnosis and treatment timing remain a subject of debate.
- Radiological screening for CDH in infants is a widely discussed public health measure.
- Assessing the cost-benefit ratio and radiation risks is crucial for evaluating screening programs.
Purpose of the Study:
- To evaluate the cost-benefit ratio of radiological mass screening for congenital dislocated hip at 3-4 months of age.
- To compare the socio-economic costs and radiation risks associated with early versus late CDH detection.
- To determine the overall impact of early screening on patient outcomes and population health.
Main Methods:
- Cost-benefit analysis comparing early (3-4 months) and late (after 9 months) detection of CDH.
- Calculation of treatment costs, including X-ray examinations for screened infants.
- Assessment of radiation exposure risks, including potential for leukemia or genetic disorders.
Main Results:
- The cost-benefit ratio for early detection (3-4 months) is 3.6, significantly lower than late detection (84,230 FF vs. 23,374 FF).
- In populations with a 2% CDH frequency, the cost-benefit ratio increases to 4.57.
- Early diagnosis results in substantially lower patient irradiation compared to delayed treatment.
Conclusions:
- Systematic pelvic X-ray screening at 3-4 months favors early CDH detection, offering a favorable cost-benefit ratio.
- The reduced radiation exposure from early screening outweighs the risks associated with mass screening of healthy infants.
- Implementing obligatory mass radiological screening requires comprehensive radiologist training in radiation protection and image acquisition.
Abstract:
The question of radiological mass screening for congenital dislocated hip is still debated. We have tried to evaluate the cost-benefit ratio of radiological detection at the age of 3-4 months, taking into account the socio-economic cost and radiation risk. Assuming a frequency of this disorder of 1% the average cost of treatment of one case detected by X-ray screening at the age of 3-4 months, including the price of X-ray examinations of 99 normal babies, is 23,374 FF. The average cost of treatment of a case detected when walking (i.e. after 9 months) is 84,230 FF. The cost-benefit ratio is 3.6. In countries where the frequency reaches 2% the cost benefit ratio is 4.57. It also appears from our study that the irradiation of the patient is much smaller when the diagnosis is made earlier. Comparing the slight irradiation delivered to normal infants by this mass screening to the heavy irradiation received by a few individuals whose treatment is started after 9 months, the calculated risk of leukemia or of genetic disorder for the whole population still favours a systematic X-ray film of the pelvis at age 3-4 months. However, if it were decided to make obligatory this mass radiological detection programme during the fourth month of life, this would necessitate a serious effort to train all radiologists to obtain adequate films with the best radiation protection.