PS2-42 COST EFFECTIVENESS OF PULSE OXIMETRY SCREENING FOR CRITICAL CONGENITAL HEART DEFECTS IN ONTARIO, CANADA

Monday, October 24, 2016
Bayshore Ballroom ABC, Lobby Level (Westin Bayshore Vancouver)
Poster Board # PS2-42

Amit Mukerji, MD1, Amy Shafey, MD2, Amish Jain, MBBS3, Eyal Cohen, MD3, Prakesh Shah, MD, MSc2, Vibhuti Shah, MD MSc4 and Beate Sander, PhD5, (1)McMaster Children's Hospital, Hamilton, ON, Canada, (2)Mount Sinai Hospital, Toronto, ON, Canada, (3)Toronto, ON, Canada, (4)Institute of Health Policy, Management and Evaluation, University of Toronto, Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada, (5)Public Health Ontario, Toronto, ON, Canada

 

Purpose: Critical congenital heart defects (CCHDs) are a leading cause of morbidity and mortality in newborns, and late diagnosis is associated with worse outcomes. We estimated the cost-effectiveness of pulse oximetry screening (POS) in the first 24 hours to screen for CCHD in Ontario, Canada where the geographically dispersed population may present unique challenges to the implementation of such a program.

 

Methods: We performed a cost-effectiveness analysis for the Canadian context using a Markov model inputting values derived from an extensive review of literature. The base case was a 24-hour clinically stable newborn born in Ontario. The model employed the healthcare payer (ministry of health) perspective and a life-time horizon. The strategies compared were routine pulse oximetry screening versus no screening. Outcome measures, all discounted 5%, were quality-adjusted life months (QALMs), lifetime costs, and incremental cost-effectiveness ratios. Sensitivity analyses were conducted for all variables using possible ranges based on literature. All analyses were conducted using TreeAge Pro v15.

 

Results: Routine POS yielded a lifetime discounted cost of $200953.73 versus $200763.45 for no POS, an increased cost of $190.28 per individual. Routine POS yielded 228.58 discounted QALMs, compared with 228.52 for no screening for a gain of 0.06 months per individual and an incremental cost-effectiveness ratio of $3611.69 per QALM. This was below the a priori determined threshold of $4166.67 per QALM. The model was sensitive only to two variables: (1) the per-cycle cost of post-CCHD repair with no morbidity and (2) the per-cycle transitional probability of death in patients post-CCHD with no morbidity (Figure).

 

Conclusions: Based on our model using Canadian-specific data, routine POS is a cost-effective endeavour. Further refinement of our estimate may be achieved based on data once available from Canadian centers where POS has already been implemented.

 

Figure: Graphical representation of one-way sensitivity analyses of the two variable ranges where threshold was crossed. Figure panel A: Per-cycle cost of a patient with post-CCHD repair with no morbidity. Figure panel B: Transitional probability of death per cycle in patients post- CCHD repair without morbidity.

 

 

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