COST EFFECTIVENESS OF ROUTINE PULSE OXIMETRY EXAMINATION OF NEWBORNS IN THE UNITED STATES

Purpose: The use of pulse oximetry to examine asymptomatic newborn infants for critical congenital heart disease (CCHD) is increasing in practice but its cost effectiveness remains to be determined.

Methods: We set up a cost-effectiveness analysis from the health care system perspective for three scenarios reflecting a range of assumptions about costs as well as mortality from undetected CCHD. Key cost parameters are labor cost, which depends on the type of personnel and the examination time; equipment cost, which depends on the number of infants examined; and follow-up costs, which depend on the number of infants referred for echocardiography. We project that 40 to 80 infants die each year in the United States from late detected CCHD of whom 68% could have been detected through routine pulse oximetry prior to discharge. Each infant death is assumed to save 19.8 discounted life-years for children with single-ventricle cardiac defects and 28.3 years for double-ventricle defects. We assumed that definitive diagnostic testing (echocardiography) would not extend hospital stay or require transfer to a tertiary facility and that early detection of CCHD would not affect hospitalization costs, morbidity, or quality of life.

Results: The average cost is US$0.99 per infant in a scenario in which pulse oximetry is performed by technicians after 24 hours with a 0.06% refer rate and an average time of 45 seconds and with one pulse oximeter per 2500 infants; US$2.95 per infant if screening is done by nurses at an average time of 2.0 minutes and a similar refer rate but with one pulse oximeter for 1,250 infants per year; and US$5.23 per infant if screening is screening is done within the first 24 hours by nurses at an average time of 3.0 minutes, a refer rate of 0.20%, and with one pulse oximeter for 800 infants per year. Each scenario presumed the availability of pediatric echocardiography prior to hospital discharge, at an average cost of US$445. Early detection of cases of CCHD was assumed to avert 0.122, 0.062, or 0.033 infant deaths per 10,000 infants screened, respectively, yielding cost-effectiveness ratios of US$3,087, US$10,165, or US$61,262 per life-year saved, respectively.

Conclusions: Routine pulse oximetry examination of newborns in hospitals with pediatric echocardiography appears cost effective under a range of assumptions about methods and costs.