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Cost-effectiveness of alternative screening strategies for developmental dysplasia of the hip
K Rosendahl1, T Markestad, R T Lie
1Department of Pediatric Radiology, University Hospital, Bergen, Norway.
Insights
General ultrasound screening for developmental dysplasia of the hip (DDH) is cost-effective, especially when screening all girls and at-risk boys. This approach reduces late-stage treatment costs for DDH.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Health Economics
Background:
- Developmental dysplasia of the hip (DDH) screening strategies vary, impacting clinical outcomes and healthcare costs.
- Previous studies suggested potential benefits of general ultrasound screening over selective or no screening for DDH.
Purpose of the Study:
- To compare the cost-effectiveness of general versus selective ultrasound screening for DDH.
- To analyze screening program costs using data from a large randomized study of 11,925 newborns.
Main Methods:
- Utilized data from a randomized study comparing three DDH screening strategies: general ultrasound, selective ultrasound, and no ultrasound.
- Applied cost estimates for screening, early/late DDH treatment, and follow-up for each strategy.
- Modeled a hypothetical program screening all girls and at-risk boys.
Main Results:
- Total program costs were similar across the three initial strategies (<5% variation).
- General screening significantly reduced the proportion of total costs attributed to late DDH treatment (22% vs. 65%).
- Screening all girls and at-risk boys showed substantially reduced total program costs.
Conclusions:
- General ultrasound screening for DDH, particularly targeting all girls and at-risk boys, appears most cost-effective.
- Findings suggest that a strategy of screening all girls and boys with risk factors for DDH may be optimal.
- Comparative program costs may vary based on center-specific cost applications.
Objective:
To compare the cost-effectiveness of adding either a general or a selective ultrasound screening program to the routine clinical examination for developmental dysplasia of the hip (DDH) with use of the data from a large, randomized study of 11,925 newborns.
Methods:
Our previous study comparing the clinical outcomes of three strategies for screening infants for DDH suggested (but results were not statistically significant) that general ultrasound screening resulted in fewer children requiring hospitalization and surgery for DDH than did a strategy based on ultrasound screening of the 11.8% of infants considered to be at increased risk of DDH or one with no ultrasound screening. General ultrasound screening led to early splinting of 3.4% of the newborns compared with 2.0% for the selectively screened group and 1.8% for the group not receiving ultrasound screening. Using these data, we decided on sequences and intervals of diagnostic and therapeutic actions considered to be sufficient for each regimen. We applied estimates of the costs of screening, treatment of DDH discovered early and late, and follow-up examinations to arrive at total program costs for each strategy.
Results:
Total program costs were similar for each of the three screening strategies (costs varied by < 5%). However, treatment of late cases accounted for only 22% of total costs in the group undergoing general screening vs 65% in the two latter groups. The cost estimates were sensitive to several variables. Application of the data to a hypothetical ultrasound program in which all girls and only boys at increased risk for DDH underwent an ultrasound examination showed substantially reduced total program costs.
Conclusions:
Application of costs from other centers to our data regarding frequency of clinical outcomes may yield different comparative program costs. If the findings of our clinical study can be generalized to other centers, a strategy of screening all girls and boys with risk factors for DDH may be the most cost-effective approach.