The Economic Impact of Managing Late Presentation of Developmental Dysplasia of Hip (DDH).

Anuar Rim,Mohd-Hisyamudin Hp,Ahmad Mh,Zulkiflee O

doi:10.5704/moj.1511.006

Abstract

Delayed presentation of Developmental Dysplasia of Hip (DDH) comes with challenges in treatment as well as high surgical cost. Therefore the objective of this study is to quantify the economic impact of management of late presentation of DDH during a last 3-year period. We conducted a retrospective study with analysis of DDH cases managed between years 2012 to 2014. Early and late presentations of DDH were identified and cost management for both was estimated. Out of twenty-four DDH cases, thirteen cases fulfilled the inclusion criteria. All were female with majority of them presenting with unilateral DDH predominantly of the left hip. Most patients presented after age of six months and the principal complaint was abnormal or limping gait. The grand total cost for managing DDH during the three years period was USD 12,385.51, with 86% of the amount having been used to manage late presentation of DDH that was mostly contributed by the cost of surgery. We concluded that delayed presentation of DDH contributes heavily to high national expenditure. Early detection of DDH cases with systematic neonatal screening may help to minimize the incidence of the late presenting DDH and subsequently reduce the economic burden to the government.

Highlights

The incidence of Developmental Dysplasia of Hip (DDH) varies among countries
The documented incidence of late presentation of DDH is alarming since almost half of DDH cases in India presented after one year of age and about 80% of cases in University of Malaya Medical Centre (UMMC) came only after age of four months
Developmental Dysplasia of Hip (DDH) is a spectrum of hip pathology that can present as hip subluxation or complete hip dislocation with dysplastic acetabulum

Summary

Introduction

The incidence of Developmental Dysplasia of Hip (DDH) varies among countries. In Malaysia, it was reported as 0.7 to 12.2 per 1,000 live births .1-2 The documented incidence of late presentation of DDH is alarming since almost half of DDH cases in India presented after one year of age and about 80% of cases in University of Malaya Medical Centre (UMMC) came only after age of four months .3-4 In general, the management of the DDH - largely depends on the age of the children’s - first presentation to the orthopaedic surgeon. The early detection of DDH has better outcome and prognosis and the potential of being treated non-operatively, whereas in delayed presentation of DDH the majority of them are managed by surgical intervention. The surgical options in managing the late presentation group depends mainly on age of the patients as well as the severity of the dysplastic hip at the time of presentation. The older child with severe hip problem may require more complex surgery involving bony procedures. These surgeries will come with a significant cost compared to non-operative treatment in early detection of DDH cases. As there is no recent data on cost estimation in managing late presentation of DDH, we conducted this study to quantify financial impact of management of patients with delayed presentation of DDH in our centre

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