Abstract
BackgroundIn many countries, economic assessments of the routine use of pulse oximetry in the detection of Critical Congenital Heart Disease (CCHD) at birth has not yet been carried out. CCHDs necessarily require medical intervention within the first months of life. This assessment is a priority in low and medium resource countries. The purpose of this study was to assess the cost-effectiveness (CE) relation of pulse oximetry in the detection of cases of CCHD in Colombia.MethodsA full economic assessment of the cost-effectiveness type was conducted from the perspective of society. A decision tree was constructed to establish a comparison between newborn physical examination plus pulse oximetry, versus physical examination alone, in the diagnosis of CCHDs. The sensitivity and specificity of pulse oximetry were estimated from a systematic review of the literature; to assess resource use, micro-costing analyses and surveys were conducted. The time horizon of the economic evaluation was the first week after birth and until the first year of life. The incremental cost-effectiveness ratio (ICER) was determined and, to control for uncertainty, deterministic and probabilistic sensitivity analysis were made, including the adoption of different scenarios of budgetary impact. All costs are expressed in US dollars from 2017, using the average exchange rate for 2017 [$2,951.15 COP for 1 dollar].ResultsThe costs of pulse oximetry screening plus physical examination were $102; $7 higher than physical examination alone. The effectiveness of pulse oximetry plus the physical examination was 0.93; that is, 0.07 more than the physical examination on its own. The ICER was $100 for pulse oximetry screening; that is, if one wishes to increase 1% the probability of a correct CCHD diagnosis, this amount would have to be invested. A willingness to pay of $26.292 USD (direct medical cost) per probability of a correct CCHD diagnosis was assumed.ConclusionsAt current rates and from the perspective of society, newborn pulse oximetry screening at 24 h in addition to physical examination, and considering a time horizon of 1 week, is a cost-effective strategy in the early diagnosis of CCHDs in Colombia.Trial registration “retrospectively registered”.
Highlights
In many countries, economic assessments of the routine use of pulse oximetry in the detection of Critical Congenital Heart Disease (CCHD) at birth has not yet been carried out
This study included direct and indirect costs associated with the outcomes, which are covered by the general social security system (SGSSS) and families, and compared the use of pulse oximetry screening in addition to general physical examination with the general physical examination alone
The incremental cost-effectiveness ratio (ICER) was $100 for pulse oximetry screening; that is, if one wishes to increase in 1% the probability of a correct CCHD diagnosis, this amount would have to be invested (Table 5)
Summary
Economic assessments of the routine use of pulse oximetry in the detection of Critical Congenital Heart Disease (CCHD) at birth has not yet been carried out. Amongst the main CCHDs we find Pulmonary Atresia, Tetralogy of Fallot, Tricuspid Atresia, Truncus Arteriosus, Hypoplastic Left Heart Syndrome, Total Anomalus Pulmonary Venous Return and the Transposition of Great Vessels. These diseases generate an important morbidity and mortality burden from the first month of the infant’s life, and it is necessary to perform surgical and/or early interventional treatment [2, 4]. This detection may take place in different ways before birth, as in the case of prenatal ultrasound and anatomic ultrasound testing. Almost 30% of newborns affected are diagnosed late [5], which means an untimely medical-surgical intervention, with a high morbidity and mortality rate [6]
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