title: Cost-effectiveness of routine screening for critical congenital heart disease in US newborns.
abstract: OBJECTIVE
  Clinical evidence indicates newborn critical congenital heart disease (CCHD) screening through pulse oximetry is lifesaving. In 2011, CCHD was added to the US Recommended Uniform Screening Panel for newborns. Several states have implemented or are considering screening mandates. This study aimed to estimate the cost-effectiveness of routine screening among US newborns unsuspected of having CCHD.
  
  
  METHODS
  We developed a cohort model with a time horizon of infancy to estimate the inpatient medical costs and health benefits of CCHD screening. Model inputs were derived from new estimates of hospital screening costs and inpatient care for infants with late-detected CCHD, defined as no diagnosis at the birth hospital. We estimated the number of newborns with CCHD detected at birth hospitals and life-years saved with routine screening compared with no screening.
  
  
  RESULTS
  Screening was estimated to incur an additional cost of $6.28 per newborn, with incremental costs of $20 862 per newborn with CCHD detected at birth hospitals and $40 385 per life-year gained (2011 US dollars). We estimated 1189 more newborns with CCHD would be identified at birth hospitals and 20 infant deaths averted annually with screening. Another 1975 false-positive results not associated with CCHD were estimated to occur, although these results had a minimal impact on total estimated costs.
  
  
  CONCLUSIONS
  This study provides the first US cost-effectiveness analysis of CCHD screening in the United States could be reasonably cost-effective. We anticipate data from states that have recently approved or initiated CCHD screening will become available over the next few years to refine these projections.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. cora.peterson@cdc.hhs.gov
authors.forename: Cora
authors.initials: C
authors.lastname: Peterson
authors.forename: Scott D
authors.initials: SD
authors.lastname: Grosse
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Oster
authors.forename: Richard S
authors.initials: RS
authors.lastname: Olney
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Cassell
mesh_terms: D002423:Cause of Death; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000191:economics; D057210:Delayed Diagnosis / Q000191:economics; D003696:Delivery Rooms; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000191:economics* / Q000401:mortality; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000191:economics*; D010092:Oximetry / Q000191:economics*; D019057:Quality-Adjusted Life Years; D015996:Survival Rate; D014481:United States
keywords: congenital heart defects; costs and cost analysis; neonatal screening
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