ECONOMIC EVALUATION OF POSTNATAL OXIMETRY SCREENING FOR CONGENITAL HEART DEFECTS IN CHINA

Purpose: Pulse oximetry screening is a highly accurate tool for the early detection of congenital heart disease (CHD) in newborn infants. As the technique is simple, non-invasive and inexpensive, it has high potential benefits for developing countries. However, certain barriers may impede its wider implementation. In this study, we aim to inform clinical and health policy decisions by assessing the cost-effectiveness of CHD screening in China.

Method(s): We developed a cohort model to evaluate the cost-effectiveness of screening all Chinese newborns annually using three possible screening options compared to no intervention: (1) pulse oximetry alone, (2) clinical assessment alone, and (3) pulse oximetry as an adjunct to clinical assessment. We calculated the incremental cost per averted disability-adjusted life years (DALYs) in 2015 US dollars to measure cost-effectiveness. One-way sensitivity analyses and multivariate probabilistic sensitivity analysis were performed to test robustness of the model.

Result(s): We found that clinical assessment is the most cost-effective strategy compared to no intervention with an incremental cost-effectiveness ratio (ICER) of USD22,079/DALY, while pulse oximetry plus clinical assessment with the highest ICER yielded the best health outcomes. Sensitivity analysis showed that when the treatment rate increased up to 68%, pulse oximetry plus clinical assessment showed the best expected values among the three screening options. Cost-effectiveness acceptability curve analysis showed a 95% probability of clinical assessment to be cost-effective at a willingness-to-pay threshold of three times the GDP per capita.

Conclusion(s): In China, clinical assessment is currently the most cost-effective screening approach for neonatal CHD. Improvement of accessibility to treatment is crucial to expand the potential health benefits of screening.