Cost-effectiveness analysis of newborn pulse oximetry screening to detect critical congenital heart disease in Colombia

Abstract

Background 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. 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. Methods A 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]. Results The 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. Conclusions At 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”.

The Methodological Quality and Challenges in Conducting Economic Evaluations of Newborn Screening: A Scoping Review

“…After duplicate removals, 716 articles were considered eligible for screening by title and abstract. After full-text screening, 35 articles were included for the final assessment (see Appendix C for the PRISMA flow diagram) [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. No additional studies were found on the websites of the INAHTA HTA agencies.…”

“…In some EEs, screening costs were estimated using a micro-costing approach. More specifically, they used a “time-and-motion” approach to derive cost estimates (tracking the time to perform the test and multiplying it by the value of average hourly compensation of the personnel involved) [ 39 , 47 , 49 , 53 , 56 ].…”

“…Several EEs also used additional methods to explore other types of uncertainty. Some studies presented the results under different model structure/input assumptions (for instance, sensitivity and specificity of the screening test) through different scenario analyses [ 24 , 36 , 38 , 40 , 47 , 56 ].…”

The power of health economics and outcomes research (HEOR) in making decisions that matter

“…The rationale for establishing thresholds for costeffectiveness is driven by the fact that financial resources for healthcare systems are limited, and therefore, decisions on approval must balance out both value regarding health benefits and economic burden for the overall system (i.e., costs). Examples of cost-effectiveness analysis developed in the Colombian setting are presented in Londoño et al 2019 [21] and Aponte et al [22]. For wellknown international best modeling practices for costeffectiveness analysis, refer to ISPOR [23,24].…”

Cost-Utility Analysis of Prenatal Diagnosis of Congenital Cardiac Diseases using Deep Learning

“…However, resultant potential treatment cost savings and quality of life improvements, which would have resulted in a full cost utility analysis, were rarely included in such studies. Likewise, many previous cost-effective ultrasound (US) studies were limited to reporting either the cost per detected CHD case (47)(48)(49) and/or to the diagnosis of a specific ailment, such as coarctation of the aorta (50). The cost per detected case was as high as $113,000 USD (at 2012 price levels) in the USA (48), with an antenatal ultrasound that includes five cardiac axial screening views having the lowest cost per detected case (51,52).…”