Influence of prenatal diagnosis on congenital heart defects.

The impact of prenatal detection of congenital heart defects (CHD) using the four-chamber screening examination cannot be accurately ascertained because of the wide range of detection rates that affect the cost associated with it. Assuming a screening ultrasound cost of $200 per examination, recent studies in which examiners not trained in fetal echocardiography obtained and interpreted the four-chamber view only identified 5.3% of CHD, for a cost of $476,190 per malformation. When the four-chamber screening examination was performed by an individual trained in fetal echocardiography, the detection rate increased to 55%, for a cost of $45,454 per malformation. This resulted in a savings of 90%, or $430,736. Because individuals trained in fetal echocardiography are not available to perform and interpret all of the heart screening examinations, another approach is for the fetal echocardiographer to review one to two minute video clips of the four-chamber and outflow tracts screening examination obtained by the individual performing the fetal screening examination. It is estimated that at a charge of $30 per video clip review, the cost to detect 50% of CHD would be $7,500 per defect. This would result in a reduction of 98% for the detection of CHD using current screening methods. This approach would increase the detection rate of CHD by 10-fold, remove the liability of missing CHD from the untrained individual performing the screening examination, and provide revenue to tertiary centers in which individuals skilled in fetal echocardiography could maximize their diagnostic skills.