Harper Philip, Gangadharan Rohit, Poku Daryl, Aarvold Alexander
Department of Paediatric Orthopaedic Surgery, Southampton Children's Hospital, Southampton, UK.
Department of Trauma and Orthopaedics, University Hospitals Dorset, Bournemouth, UK.
Indian J Orthop. 2021 Sep 6;55(6):1402-1409. doi: 10.1007/s43465-021-00501-7. eCollection 2020 Dec.
The aim of this study was to assess screening costs in developmental dysplasia of the hip (DDH), to provide any clarity on the cost-effectiveness of various hip screening programmes internationally.
A PROSPERO-registered systematic review was performed by examining cost analysis studies of various DDH screening programmes, including those based around clinical examination, selective ultrasound and universal ultrasound. Costs were analysed using narrative synthesis.
There were 14 studies included in this review. Two studies found that clinical hip screening is advantageous over no screening at all, both in terms of overall cost and favourable outcomes. When considering selective ultrasound imaging clinical screening, two studies found it to be more expensive, one found it cheaper and three studies calculated the overall programme costs to be similar. With universal ultrasound, four studies calculated this to be cheaper than clinical or selective ultrasound screening due to a reduced late detection and surgery rate. However, a comparable number of studies concluded that the increased financial costs of universal ultrasound were greater than the reduction in surgical costs. No studies included any long-term data.
There is a dearth of information on DDH screening costs, with significant heterogeneity amongst the existing literature. Future research should include the cost analysis of long-term complications of DDH, including the social and psychological impact of early onset arthritis, as well as gender specific ultrasound screening programmes.
本研究旨在评估发育性髋关节发育不良（DDH）的筛查成本，以明确国际上各种髋关节筛查项目的成本效益。
通过审查各种DDH筛查项目的成本分析研究进行一项在PROSPERO注册的系统评价，包括基于临床检查、选择性超声和普遍超声的项目。使用叙述性综合分析成本。
本评价纳入了14项研究。两项研究发现，临床髋关节筛查在总成本和良好结果方面均优于完全不进行筛查。在比较选择性超声成像与临床筛查时，两项研究发现前者成本更高，一项发现更便宜，三项研究计算出总体项目成本相似。对于普遍超声，四项研究计算得出由于后期检测和手术率降低，其比临床或选择性超声筛查更便宜。然而，相当数量的研究得出结论，普遍超声增加的财务成本大于手术成本的降低。没有研究纳入任何长期数据。
关于DDH筛查成本的信息匮乏，现有文献之间存在显著异质性。未来的研究应包括DDH长期并发症的成本分析，包括早发性关节炎的社会和心理影响，以及针对性别的超声筛查项目。
