Newborn screening for critical CHD is cost-effective

Laurie Barclay

August 13, 2013

Atlanta, GA - Newborn screening for critical congenital heart disease (CCHD) in the US could be reasonably cost-effective, according to the first US cost-effectiveness analysis of such screening, published online August 5, 2013 in Pediatrics[1].

"Clinical evidence indicates newborn [CCHD] screening through pulse oximetry is lifesaving," write Dr Cora Peterson (National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA) and colleagues. "In 2011, CCHD was added to the US recommended uniform screening panel for newborns. Several states have implemented or are considering screening mandates."

To estimate the inpatient medical costs and health benefits during infancy for newborn CCHD screening, the investigators developed a cohort model for infants with late-detected CCHD, defined as no diagnosis of CCHD at the birth hospital.

For each newborn screened, the estimated additional cost in 2011 US dollars was $6.28. If all hospitals used reusable sensors, however, the incremental cost of screening might be as low as $0.50 per newborn.

For CCHD detected at birth hospitals, incremental costs would be $20 862 per newborn and $40 385 per life-year gained. The model projected that screening would result in 1189 more newborns with CCHD identified at birth hospitals and 20 infant deaths prevented annually.

Although the model suggested that there would be 1975 false positives annually, the researchers say they had little effect on total estimated costs.

Clinical implications and study limitations

"Based on input from recent studies, CCHD screening appears cost-effective using conventional thresholds and may be cost-saving under some circumstances," the study authors write. "We anticipate data from US states that have recently approved or initiated routine CCHD screening will become available over the next few years to refine these projections."

Limitations of this analysis include a possible lack of generalizability to all states, possible errors in reported birth defects, that costs and benefits were estimated only during infancy, and a lack of estimates regarding the costs and health benefits of detecting non-CCHD conditions through CCHD screening. In addition, the analysis assumed full life expectancy for infants with CCHD who do not die because of late detection of CCHD, but life expectancy varies substantially by CCHD type.

"Future analyses should go beyond our cost approach to include differences in non-inpatient healthcare costs during and beyond infancy," the study authors conclude. "Comparative data on healthcare resource utilization among children with CCHD who received timely diagnoses during their newborn period could facilitate a future cost-effectiveness analysis of CCHD screening with a longer time horizon. . . . A future detailed analysis of mortality among infants with late-detected CCHD could also provide information to further refine model assumptions regarding deaths potentially avoidable through CCHD screening."

This study received no externa l funding. The authors have disclosed no relevant financial relationships.

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