National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Pediatrics. 2013 Sep;132(3):e595-603. doi: 10.1542/peds.2013-0332. Epub 2013 Aug 5.
Clinical evidence indicates newborn critical congenital heart disease (CCHD) screening through pulse oximetry is lifesaving. In 2011, CCHD was added to the US Recommended Uniform Screening Panel for newborns. Several states have implemented or are considering screening mandates. This study aimed to estimate the cost-effectiveness of routine screening among US newborns unsuspected of having CCHD.
We developed a cohort model with a time horizon of infancy to estimate the inpatient medical costs and health benefits of CCHD screening. Model inputs were derived from new estimates of hospital screening costs and inpatient care for infants with late-detected CCHD, defined as no diagnosis at the birth hospital. We estimated the number of newborns with CCHD detected at birth hospitals and life-years saved with routine screening compared with no screening.
Screening was estimated to incur an additional cost of $6.28 per newborn, with incremental costs of $20 862 per newborn with CCHD detected at birth hospitals and $40 385 per life-year gained (2011 US dollars). We estimated 1189 more newborns with CCHD would be identified at birth hospitals and 20 infant deaths averted annually with screening. Another 1975 false-positive results not associated with CCHD were estimated to occur, although these results had a minimal impact on total estimated costs.
This study provides the first US cost-effectiveness analysis of CCHD screening in the United States could be reasonably cost-effective. We anticipate data from states that have recently approved or initiated CCHD screening will become available over the next few years to refine these projections.
临床证据表明，通过脉搏血氧仪对新生儿进行先天性心脏病（CCHD）的临界筛查具有救生作用。2011 年，CCHD 被添加到美国新生儿推荐统一筛查计划中。一些州已经实施或正在考虑进行筛查授权。本研究旨在评估对未怀疑患有 CCHD 的美国新生儿进行常规筛查的成本效益。
我们开发了一个队列模型，时间范围为婴儿期，以估计 CCHD 筛查的住院医疗费用和健康效益。模型输入来自新的医院筛查成本估计和婴儿迟发性 CCHD 住院护理成本，迟发性 CCHD 定义为在出生医院没有诊断。我们估计了在出生医院发现的患有 CCHD 的新生儿数量以及与不筛查相比常规筛查可以挽救的生命年数。
筛查估计会使每个新生儿增加 6.28 美元的额外成本，在出生医院发现 CCHD 的每个新生儿的增量成本为 20862 美元，每个生命年获得的增量成本为 40385 美元（2011 年美元）。我们估计，在出生医院将发现 1189 名患有 CCHD 的新生儿，每年可避免 20 名婴儿死亡。尽管这些结果对总估计成本的影响最小，但估计会出现 1975 例与 CCHD 无关的假阳性结果。
本研究首次在美国进行了 CCHD 筛查的成本效益分析，结果表明 CCHD 筛查具有合理的成本效益。我们预计，在未来几年内，最近批准或启动 CCHD 筛查的各州的数据将变得可用，以完善这些预测。
