Cost-Effectiveness of Routine Screening for Critical Congenital Heart Disease in US Newborns

• Authors: Cora Peterson, Centers for Disease Control and Prevention; Scott D. Grosse, Centers for Disease Control and Prevention; Matthew Oster, Emory University; Richard Olney, Emory University; Cynthia H. Cassell, Centers for Disease Control and Prevention
• Journal Title: PEDIATRICS
• Volume: Volume 132, Number 3
• Publisher: AMER ACAD PEDIATRICS | 2013-09-01, Pages E595-E603
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1542/peds.2013-0332
• Subjects: Health Sciences, Medicine and Surgery; Biology, Anatomy; Biology, Genetics
• Keywords: Science & Technology; Life Sciences & Biomedicine; Pediatrics; congenital heart defects; neonatal screening; costs and cost analysis; PULSE OXIMETRY; DEFECTS; STRATEGIES

Abstract

OBJECTIVES: Clinical evidence indicates newborn critical congenital heart disease (CCHD) screening through pulse oximetry is lifesaving. In 2011, CCHD was added to the US Recommended Uniform Screening Panel for newborns. Several states have implemented or are considering screening mandates. This study aimed to estimate the costeffectiveness of routine screening among US newborns unsuspected of having CCHD. METHODS: We developed a cohort model with a time horizon of infancy to estimate the inpatient medical costs and health benefits of CCHD screening. Model inputs were derived from new estimates of hospital screening costs and inpatient care for infants with late-detected CCHD, defined as no diagnosis at the birth hospital. We estimated the number of newborns with CCHD detected at birth hospitals and life-years saved with routine screening compared with no screening. RESULTS: Screening was estimated to incur an additional cost of $6.28 per newborn, with incremental costs of $20 862 per newborn with CCHD detected at birth hospitals and $40 385 per life-year gained (2011 US dollars). We estimated 1189 more newborns with CCHD would be identified at birth hospitals and 20 infant deaths averted annually with screening. Another 1975 false-positive results not associated with CCHD were estimated to occur, although these results had a minimal impact on total estimated costs. CONCLUSIONS: This study provides the first US cost-effectiveness analysis of CCHD screening in the United States could be reasonably cost-effective. We anticipate data from states that have recently approved or initiated CCHD screening will become available over the next few years to refine these projections.