COST-EFFECTIVENESS OF ALTERNATIVE SCREENING STRATEGIES FOR DEVELOPMENTAL DYSPLASIA OF THE HIP

Objective: To compare the cost-effectiveness of adding either a genera l or a selective ultrasound screening program to the routine clinical examination for developmental dysplasia of the hip (DDH) with use of t he data from a large, randomized study of 11925 newborns. Methods: Our previous study comparing the clinical outcomes of three strategies fo r screening infants for DDH suggested (but results were not statistica lly significant) that general ultrasound screening resulted in fewer c hildren requiring hospitalization and surgery for DDH than did a strat egy based on ultrasound screening of the 11.8% of infants considered t o be at increased risk of DDH or one with no ultrasound screening. Gen eral ultrasound screening led to early splinting of 3.4% of the newbor ns compared with 2.0% for the selectively screened group and 1.8% for the group not receiving ultrasound screening. Using these data, we dec ided on sequences and intervals of diagnostic and therapeutic actions considered to be sufficient for each regimen. We applied estimates of the costs of screening, treatment of DDH discovered early and late, an d follow-up examinations to arrive at total program costs for each str ategy. Results: Total program costs were similar for each of the three screening strategies (costs varied by <5%). However, treatment of lat e cases accounted for only 22% of total costs in the group undergoing general screening vs 65% in the two latter groups. The cost estimates were sensitive to several variables. Application of the data to a hypo thetical ultrasound program in which all girls and only boys at increa sed risk for DDH underwent an ultrasound examination showed substantia lly reduced total program costs. Conclusions: Application of costs fro m other centers to our data regarding frequency of clinical outcomes m ay yield different comparative program costs. If the findings of our c linical study can be generalized to other centers, a strategy of scree ning all girls and boys with risk factors for DDH may be the most cost -effective approach.