Rosendahl K, Markestad T, Lie R T, Sudmann E, Geitung J T
Department of Pediatric Radiology, University Hospital, Bergen, Norway.
Arch Pediatr Adolesc Med. 1995 Jun;149(6):643-8.
To compare the cost-effectiveness of adding either a general or a selective ultrasound screening program to the routine clinical examination for developmental dysplasia of the hip (DDH) with use of the data from a large, randomized study of 11,925 newborns.
Our previous study comparing the clinical outcomes of three strategies for screening infants for DDH suggested (but results were not statistically significant) that general ultrasound screening resulted in fewer children requiring hospitalization and surgery for DDH than did a strategy based on ultrasound screening of the 11.8% of infants considered to be at increased risk of DDH or one with no ultrasound screening. General ultrasound screening led to early splinting of 3.4% of the newborns compared with 2.0% for the selectively screened group and 1.8% for the group not receiving ultrasound screening. Using these data, we decided 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, and follow-up examinations to arrive at total program costs for each strategy.
Total program costs were similar for each of the three screening strategies (costs varied by < 5%). However, treatment of late 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 hypothetical ultrasound program in which all girls and only boys at increased risk for DDH underwent an ultrasound examination showed substantially reduced total program costs.
Application of costs from other centers to our data regarding frequency of clinical outcomes may yield different comparative program costs. If the findings of our clinical study can be generalized to other centers, a strategy of screening all girls and boys with risk factors for DDH may be the most cost-effective approach.
利用一项针对11925名新生儿的大型随机研究数据，比较在髋关节发育不良（DDH）的常规临床检查基础上增加常规超声筛查或选择性超声筛查方案的成本效益。
我们之前比较三种DDH筛查策略临床结果的研究表明（但结果无统计学意义），与基于对11.8%被认为DDH风险增加的婴儿进行超声筛查的策略或不进行超声筛查的策略相比，常规超声筛查导致因DDH需要住院和手术的儿童更少。常规超声筛查导致3.4%的新生儿早期使用夹板，而选择性筛查组为2.0%，未接受超声筛查组为1.8%。利用这些数据，我们确定了每种方案认为足够的诊断和治疗行动的顺序和间隔。我们应用筛查、早期和晚期发现的DDH的治疗以及随访检查的成本估计，得出每种策略的总方案成本。
三种筛查策略中每种策略的总方案成本相似（成本差异<5%）。然而，在常规筛查组中，晚期病例的治疗仅占总成本的22%，而后两组为65%。成本估计对几个变量敏感。将数据应用于一个假设的超声检查方案，即所有女孩以及只有DDH风险增加的男孩接受超声检查，结果显示总方案成本大幅降低。
将其他中心的成本应用于我们关于临床结果频率的数据可能会产生不同的比较方案成本。如果我们临床研究的结果能够推广到其他中心，对所有有DDH风险因素的女孩和男孩进行筛查的策略可能是最具成本效益的方法。
