Ultrasound screening of the neonatal hip: Cost-benefit analysis

Aim. To explore the economic justification for introducing ultrasound scree ning for developmental dysplasia of the hip in Croatia. Methods. The analysis was based on the two formulas: that cost-benefit equa ls benefit/cost, and that net benefit equals benefit minus cost. Screening costs were expressed as a sum of training costs and fee for ultrasound scre ening of neonates. The neonatologists' working hours and utilization of ult rasound instruments were expressed by multiplying the number of infants bor n per year in Croatia (N=47,792) with the standard time needed for one exam ination and then dividing the product by the number of employed neonatologi sts (N=54) and number of ultrasound instruments (N=58). The benefit was exp ressed as a late case treatment costs and screening costs ratio. Savings, w hich would have resulted from the reduction in expected treatment costs of patients with hip problems at later age, represent the indirect benefit. Results. Total hip screening costs would have amounted to US$329,537.80, in cluding the training costs of US$31,035.90. On the average, a neonatologist would spend 71.4 hours screening per year, whereas the instrument utilizat ion would be 64.7 hours. An ultrasound-screening program would save annuall y US$195,336.50, compared with the existing diagnostic approach. The treatm ent costs without ultrasound screening were 1.6 times higher than the scree ning costs. Hospital treatment costs for 165 patients needing endoprosthesi s would cover the total screening program in the whole country. Conclusion. It is economically justified to introduce ultrasound screening for developmental dysplasia of the hip in neonates in Croatia, a country wi th transitional and developing economy.