title: Pulse oximetry as a screening test for congenital heart defects in newborn infants: a cost-effectiveness analysis.
abstract: OBJECTIVE
  To undertake a cost-effectiveness analysis that compares pulse oximetry as an adjunct to clinical examination with clinical examination alone in newborn screening for congenital heart defects (CHDs).
  
  
  METHODS
  Model-based economic evaluation using accuracy and cost data from a primary study supplemented from published sources taking an NHS perspective.
  
  
  METHODS
  Six large maternity units in the UK.
  
  
  METHODS
  20 055 newborn infants prior to discharge from hospital.
  
  
  METHODS
  Pulse oximetry as an adjunct to clinical examination.
  
  
  METHODS
  Cost effectiveness based on incremental cost per timely diagnosis.
  
  
  RESULTS
  Pulse oximetry as an adjunct to clinical examination is twice as costly but provides a timely diagnosis to almost 30 additional cases of CHD per 100 000 live births compared with a modelled strategy of clinical examination alone. The incremental cost-effectiveness ratio for this strategy compared with clinical examination alone is approximately £24 000 per case of timely diagnosis in a population in which antenatal screening for CHDs already exists. The probabilistic sensitivity analysis suggests that at a willingness-to-pay (WTP) threshold of £100 000, the probability of 'pulse oximetry as an adjunct to clinical examination' being cost effective is more than 90%. Such a WTP threshold is plausible if a newborn with timely diagnosis of a CHD gained just five quality-adjusted life years, even when treatment costs are taken into consideration.
  
  
  CONCLUSIONS
  Pulse oximetry as an adjunct to current routine practice of clinical examination alone is likely to be considered a cost-effective strategy in the light of currently accepted thresholds.
authors.affiliation: Health Economics Unit, School of Health and Populations Science, University of Birmingham, Birmingham, UK. t.e.roberts@bham.ac.uk
authors.forename: T E
authors.initials: TE
authors.lastname: Roberts
authors.forename: P M
authors.initials: PM
authors.lastname: Barton
authors.forename: P E
authors.initials: PE
authors.lastname: Auguste
authors.forename: L J
authors.initials: LJ
authors.lastname: Middleton
authors.forename: A T
authors.initials: AT
authors.lastname: Furmston
authors.forename: A K
authors.initials: AK
authors.lastname: Ewer
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D017059:Models, Econometric; D015997:Neonatal Screening / Q000191:economics* / Q000379:methods; D010092:Oximetry / Q000191:economics*; D006113:United Kingdom / Q000453:epidemiology