Pulse oximetry as a screening test for congenital heart defects in newborn infants: a cost-effectiveness analysis
- 1Health Economics Unit, School of Health and Populations Science, University of Birmingham, Birmingham, UK
- 2Clinical Trials Unit, University of Birmingham, Birmingham, UK
- 3School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
- 4Birmingham Women's Healthcare NHS Foundation Trust, University of Birmingham, Birmingham, UK
- Correspondence to Tracy E Roberts, Professor of Health Economics, Health Economics Unit, School of Health and Population Sciences, The Public Health Building, University of Birmingham, Birmingham B15 2TT, UK; t.e.roberts{at}bham.ac.uk
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Contributors TER designed and managed the economic evaluation for the project and wrote the paper. PB advised on the model-based economic evaluation, interpretation of the results and edited the paper. PA carried out the economic analysis under the supervision of TER, collated the cost data and edited the paper. LJM contributed to the accuracy study design, performed the statistical analysis for the test accuracy study and edited the paper. ATF was trial coordinator, contributed to the accuracy study design and ensured that the protocol was implemented, prepared data for analysis and reporting, and edited the paper. AKE designed and managed the accuracy project and edited the paper. Tracy Roberts is the Guarantor.
- Received 27 June 2011
- Accepted 14 December 2011
- Published Online First 13 January 2012
Abstract
Objective To undertake a cost-effectiveness analysis that compares pulse oximetry as an adjunct to clinical examination with clinical examination alone in newborn screening for congenital heart defects (CHDs).
Design Model-based economic evaluation using accuracy and cost data from a primary study supplemented from published sources taking an NHS perspective.
Setting Six large maternity units in the UK.
Patients 20 055 newborn infants prior to discharge from hospital.
Intervention Pulse oximetry as an adjunct to clinical examination.
Main outcome measure Cost effectiveness based on incremental cost per timely diagnosis.
Results Pulse oximetry as an adjunct to clinical examination is twice as costly but provides a timely diagnosis to almost 30 additional cases of CHD per 100 000 live births compared with a modelled strategy of clinical examination alone. The incremental cost-effectiveness ratio for this strategy compared with clinical examination alone is approximately £24 000 per case of timely diagnosis in a population in which antenatal screening for CHDs already exists. The probabilistic sensitivity analysis suggests that at a willingness-to-pay (WTP) threshold of £100 000, the probability of ‘pulse oximetry as an adjunct to clinical examination’ being cost effective is more than 90%. Such a WTP threshold is plausible if a newborn with timely diagnosis of a CHD gained just five quality-adjusted life years, even when treatment costs are taken into consideration.
Conclusion Pulse oximetry as an adjunct to current routine practice of clinical examination alone is likely to be considered a cost-effective strategy in the light of currently accepted thresholds.
Footnotes
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Funding This review was funded by the National Institute for Health Research Health Technology Assessment Programme (06/06/03).
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Competing interests None.
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Provenance and peer review Not commissioned; externally peer reviewed.
