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Influence of prenatal diagnosis on congenital heart defects
1ALFIGEN The Genetics Institute, Pasadena, California, USA. fetalecho@fetalecho.com
Insights
Prenatal screening for congenital heart defects (CHD) is more effective and cost-efficient when performed by trained specialists. A video clip review method significantly improves detection rates and reduces costs for diagnosing fetal heart conditions.
Area of Science:
- Medical Imaging
- Cardiology
- Prenatal Diagnosis
Background:
- Prenatal detection of congenital heart defects (CHD) via four-chamber screening has variable accuracy and cost-effectiveness.
- Current screening methods' impact is unclear due to wide detection rate variations.
Purpose of the Study:
- To evaluate the cost-effectiveness of different approaches to prenatal CHD screening.
- To identify methods for improving CHD detection rates and reducing associated costs.
Main Methods:
- Comparison of CHD detection rates and costs for screening by untrained examiners versus trained fetal echocardiographers.
- Analysis of a proposed model involving remote video clip review by specialists.
Main Results:
- Screening by untrained personnel identified only 5.3% of CHD at $476,190 per malformation.
- Screening by trained specialists achieved a 55% detection rate at $45,454 per malformation, a 90% cost saving.
- Video clip review by specialists is estimated to detect 50% of CHD at $7,500 per defect, a 98% reduction in cost.
Conclusions:
- Specialist-trained fetal echocardiography significantly improves CHD detection and reduces costs.
- Remote video clip review offers a scalable and cost-effective solution to enhance prenatal CHD screening.
- This approach increases detection rates tenfold, mitigates liability for untrained screeners, and generates revenue for specialized centers.
Abstract:
The impact of prenatal detection of congenital heart defects (CHD) using the four-chamber screening examination cannot be accurately ascertained because of the wide range of detection rates that affect the cost associated with it. Assuming a screening ultrasound cost of $200 per examination, recent studies in which examiners not trained in fetal echocardiography obtained and interpreted the four-chamber view only identified 5.3% of CHD, for a cost of $476,190 per malformation. When the four-chamber screening examination was performed by an individual trained in fetal echocardiography, the detection rate increased to 55%, for a cost of $45,454 per malformation. This resulted in a savings of 90%, or $430,736. Because individuals trained in fetal echocardiography are not available to perform and interpret all of the heart screening examinations, another approach is for the fetal echocardiographer to review one to two minute video clips of the four-chamber and outflow tracts screening examination obtained by the individual performing the fetal screening examination. It is estimated that at a charge of $30 per video clip review, the cost to detect 50% of CHD would be $7,500 per defect. This would result in a reduction of 98% for the detection of CHD using current screening methods. This approach would increase the detection rate of CHD by 10-fold, remove the liability of missing CHD from the untrained individual performing the screening examination, and provide revenue to tertiary centers in which individuals skilled in fetal echocardiography could maximize their diagnostic skills.