ORIGINAL ARTICLE

Efficiency of alternative policy options for screening for developmental dysplasia of the hip in the United Kingdom

J Brown¹, C Dezateux², J Karnon³, A Parnaby³, R Arthur⁴

¹ MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK
² Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH, UK
³ Health Economics Research Group, Brunel University, Uxbridge, Middlesex UB8 3PH, UK
⁴ General Infirmary at Leeds, Belmont Grove, Leeds, West Yorkshire LS2 9NS, UK

Correspondence to:
Correspondence to:
Dr J Brown, MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK;
jx.brown{at}bristol.ac.uk

Aims: To assess, using a decision model, the efficiency of ultrasound based and clinical screening strategies for developmental dysplasia of the hip.

Methods: The additional cost per additional favourable outcome was compared for the following strategies: clinical screening alone using the Ortolani and Barlow tests; addition of static and dynamic ultrasound examination of the hips of all infants (universal ultrasound) or restricted to infants with defined risk factors (selective ultrasound); "no screening" (that is, clinical diagnosis only).

Results: Ultrasound based screening strategies are predicted to be more effective but more costly than clinical screening or no screening. Estimated total costs per 100 000 live births are approximately £4 million for universal ultrasound, £3 million for selective ultrasound, £1 million for clinical screening alone, and £0.4 million for no screening. The relative efficiency of selective ultrasound and clinical screening is poorly differentiated, and depends on how infants are selected for ultrasound as well as the expertise of clinical screening examiners. If training costs less than £20 per child screened, clinical screening alone would be more efficient than selective ultrasound. Relative to no screening, each of the 16 additional favourable outcomes achieved as a result of selective ultrasound costs approximately £0.2 million, while each of the five favourable outcomes achieved through universal ultrasound screening, over and above selective ultrasound, costs approximately £0.3 million.

Conclusions: Policy choice depends on values attached to the different outcomes, willingness to pay to achieve these and total budget.

Keywords: hip dislocation; congenital; mass screening; decision trees; economics; health policy

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