Abstract
Objective: Developmental dysplasia of the hip (DDH) is a common and preventable cause of disability. Early detection of DDH (<3 months) is associated with reduced risk of surgical treatment, hence in addition to the traditional clinical screening, NIPE guidelines advocate the use of selective screening of those with DDH associated risk factors. In 2016, Cardiff and Vale University Health Board (CAVUHB) implemented a selective screening program for DDH. This research will determine the impact and up-to-date cost effectiveness of a selective screening for DDH. Methods: A retrospective study of all patients born between 1st of January 2016 and the 31st of December 2016, who underwent ultra-sonographic screening for DDH in CAVUHB. Ultrasounds were graded using Graf’s classification, treatment outcomes were determined by patient’s records and costings were based on 2016 NHS tariffs. The research took place at the University Hospital of Wales (UHW). Results: Screening of those with risk factors for DDH, but a normal examination diagnosed 72% of all DDH cases and 38% of treated DDH cases. Screening for risk factors cost CAVUHB £98914, with a cost per favorable outcome, defined as early detection and successful treatment of DDH without surgical intervention, of £12364. The mean cost of DDH treatment of a patient missed by screening was £14431. All DDH cases were detected through breech presentation or family history risk factors. Screening only those with these risk factors is more cost effective and equally successful with a cost per favorable outcome of £9095. Conclusion: The selective screening program was successful and cost effective in detecting and treating cases of DDH. However, the screening process can be made more cost-effective without reducing DDH detection rate, by omitting statistically insignificant risk factors from the screening criteria. Early detection of DDH is important for effective treatment. CAVUHB cost-effectively reduced morbidity and potential surgical mortality within the neonatal population because of its selective screening program for DDH.
Highlights
Developmental dysplasia of the hip (DDH) is recognised as a spectrum of abnormalities affecting the hip in infants and children
All DDH cases were detected through breech presentation or family history risk factors
Detection of DDH is important for effective treatment
Summary
Developmental dysplasia of the hip (DDH) is recognised as a spectrum of abnormalities affecting the hip in infants and children. From the physiologically immature hip, to pathological acetabular dysplasia with or without dislocation or subluxation of the femoral head [1]. DDH is a common and preventable cause of disability [3] and forms a large portion of paediatric orthopedic practice. A later diagnosis of DDH leads to an increased risk of surgical management and long-term complications such as early degenerative arthritis and gait disturbances [4,5]. These currently represent a large burden of care and DDH is reported as the underlying aetiology in approximately one third of hip replacements of those under 65 [6]
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