2022, Number 4
<< Back Next >>
salud publica mex 2022; 64 (4)
Cost-effectiveness analysis of pulse oximetry as a screening test for critical congenital heart defects in Mexico
García-Benítez LA, Granados-García V, Agudelo-Botero M, Mier-Martínez M, Palacios-Macedo A, Durán-Arenas L
Language: Spanish
References: 33
Page: 377-384
PDF size: 295.98 Kb.
ABSTRACT
Objective. To carry out a cost-effectiveness analysis of pulse
oximetry as a newborn screening test for critical congenital
heart defects (CCHD) in Mexico.
Materials and methods.
Economic evaluation study was conducted from the
perspective of the health care provider. A decision tree model
was used to compare between physical examination alone
and pulse oximetry screening (POS) as an additional test to
physical examination.
Results. For every 10 000 newborns,
the alternative with POS detected an additional 32 cases of
CCHD, with an incremental cost-effectiveness ratio of USD
1 219, and at a willingness-to-pay threshold of USD 25 000 for
each early detection, the probability of cost-effectiveness is
more than 90%.
Conclusion. The cost-effectiveness of POS,
as a newborn screening for CCHD, is higher in Mexico than in
high-income countries, and represents a cost-effective investment
to gain years of life in the child population of Mexico.
REFERENCES
GBD 2017 Congenital Heart Disease Collaborators. Global, regional,and national burden of congenital heart disease, 1990-2017: a systematicanalysis for the Global Burden of Disease Study 2017. Lancet ChildAdolesc Health. 2020;4(3):185-200. https://doi.org/10.1016/S2352-4642(19)30402-X
Jenkins KJ, Castañeda AR, Cherian KM, Couser CA, Dale EK, GauvreauK, et al. Reducing mortality and infections after congenital heart surgeryin the developing world. Pediatrics. 2014;134(5):e1422-e1430. https://doi.org/10.1542/peds.2014-0356
Bastero P, Staveski SL, Zheleva B, Scanlan E, Cabrera AG, Araujo A, et al.Partnership models for the establishment of sustainable paediatric cardiacsurgical and cardiac intensive care programmes in low-and middle-incomecountries. Cardiol Young. 2017;27(S6):S55-S60. https://doi.org/10.1017/S1047951117002621
Secretaría de Salud de México. CubosDinamicos.gob.mx. México:Secretaria de Salud de México/Dirección General en Información en Salud(DGIS), 2020 [citado abril 10, 2022]. Disponible en: http://www.dgis.salud.gob.mx/contenidos/basesdedatos/BD_Cubos_gobmx.html
Van Der Linde D, Konings EE, Slager MA, Witsenburg M, HelbingWA, Takkenberg JJ, et al. Birth prevalence of congenital heart diseaseworldwide: A systematic review and meta-analysis. J Am Coll Cardiol.2011;58(21):2241-7. https://doi.org/10.1016/j.jacc.2011.08.025
Plana MN, Zamora J, Suresh G, Fernandez-Pineda L, ThangaratinamS, Ewer AK. Pulse oximetry screening for critical congenital heartdefects. Cochrane Database Syst Rev. 2018;3(3):CD011912. https://doi.org/10.1002/14651858.CD011912.pub2
Aranguren HC, Londoño D, Troncoso GA, Dominguez MT, Taborda A,Fonseca A, et al. Oximetry and neonatal examination for the detection ofcritical congenital heart disease: a systematic review and meta-analysis.F1000Res. 2019;8:242. https://doi.org/10.12688/f1000research.17989.1
Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, KoppelR, et al. Role of pulse oximetry in examining newborns for congenitalheart disease: a scientific statement from the AHA and AAP. Pediatrics.2009;124(2):823-36. https://doi.org/10.1542/peds.2009-1397
Bakker MK, Bergman JE, Krikov S, Amar E, Cocchi G, Cragan J, et al.Prenatal diagnosis and prevalence of critical congenital heart defects: aninternational retrospective cohort study. BMJ Open. 2019;9(7):e028139.https://doi.org/10.1136/bmjopen-2018-028139
Eckersley L, Sadler L, Parry E, Finucane K, Gentles TL. Timing of diagnosisaffects mortality in critical congenital heart disease. Arch Dis Child.2016;101(6):516-20. https://doi.org/10.1136/archdischild-2014-307691
Peterson C, Ailes E, Riehle-Colarusso T, Oster ME, Olney RS, CassellCH, et al. Late detection of critical congenital heart disease among usinfants stimation of the potential impact of proposed universal screeningusing pulse oximetry. JAMA Pediatr. 2014;168(4):361-70. https://doi.org/10.1001/jamapediatrics.2013.4779
Granelli A, Meberg A, Ojala T, Steensberng J, Oskarsson G, MellanderM. Nordic pulse oximetry screening – implementation status and proposalfor uniform guidelines. Acta Paediatr. 2014;103(11):1136-42. https://doi.org/10.1111/apa.12758
Mikrou P, Singh A, Ewer AK. Pulse oximetry screening for criticalcongenital heart defects: a repeat UK national survey. Arch Dis ChildFetal Neonatal Ed. 2017;102(6):F558. https://doi.org/10.1136/archdischild-2017-313378
Mahle WT, Martin GR, Beekman RH, Morrow WR, Section on Cardiologyand Cardiac Surgery Executive Committee. Endorsement of healthand human services recommendation for pulse oximetry screening forcritical congenital heart disease. Pediatrics. 2012;129(1):190-2. https://doi.org/10.1542/peds.2011-3211
Martin GR, Ewer AK, Gaviglio AML, Hom LA, Saarinen AM, SontagMP, et al. Updated strategies for pulse oximetry screening for criticalcongenital heart disease. Pediatrics. 2020;146(1):e20191650. https://doi.org/10.1542/peds.2019-1650
Diario Oficial de la Federación. DECRETO por el que se adicionauna fracción II Bis al artículo 61 de la Ley General de Salud. Secretaria deGobernación [internet]. Ciudad de México: DOF, 2021 [citado abril 10,2022]. Disponible en: http://www.dof.gob.mx/nota_detalle.php?codigo=5619922&fecha=01/06/2021
Sola A, Rodríguez S, Young A, Varela LL, Villamayor RM, Cardetti M, etal. CCHD screening implementation efforts in Latin American countriesby the Ibero American Society of Neonatology (SIBEN). Int J NeonatalScreen. 2020:6(1):21. https://doi.org/10.3390/ijns6010021
Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK. Pulseoximetry screening for critical congenital heart defects in asymptomaticnewborn babies: a systematic review and meta-analysis. Lancet.2012;379(9835):2459-64. https://doi.org/10.1016/S0140-6736(12)60107-X
Ewer AK, Deshpande SA, Gale C, Stenson BJ, Upton M, Evans C, etal. Potential benefits and harms of universal newborn pulse oximetryscreening: response to the UK National Screening Committee publicconsultation. Arch Dis Child. 2020;105(11):1128-9. https://doi.org/10.1136/archdischild-2019-317859
Roberts TE, Barton PM, Auguste PE, Middleton LJ, Furmston AT,Ewer AK. Pulse oximetry as a screening test for congenital heartdefects in newborn infants: a cost-effectiveness analysis. Arch Dis Child.2012;97(3):221-6. https://doi.org/10.1136/archdischild-2011-300564
Peterson C, Grosse SD, Oster ME, Olney RS, Cassell CH. Costeffectivenessof routine screening for critical congenital heart disease inUS newborns. Pediatrics. 2013;132(3):e595-e603. https://doi.org/10.1542/peds.2013-0332
Griebsch I, Knowles RL, Brown J, Bull C, Wren C, Dezateux CA. Comparingthe clinical and economic effects of clinical examination, pulse oximetry,and echocardiography in newborn screening for congenital heartdefects: a probabilistic cost-effectiveness model and value of informationanalysis. Int J Technol Assess Health Care. 2007;23(2):192-204. https://doi.org/10.1017/S0266462307070304
Diario Oficial de la Federación. Norma Oficial Mexicana NOM-007-SSA2-2016, Para la atención de la mujer durante el embarazo, parto ypuerperio, y de la persona recién nacida. Ciudad de México: DOF, 2016[citado abril 10, 2022]. Disponible en: http://dof.gob.mx/nota_detalle.php?codigo=5432289&fecha=07/04/2016
Ewer AK, Furmston AT, Middleton LJ, Deeks J, Daniels J, Pattison H,et al. Pulse oximetry as a screening test for congenital heart defects innewborn infants: a test accuracy study with evaluation of acceptability andcost-effectiveness. Health Technol Assess. 2012;16(2):1-184. https://doi.org/10.3310/hta16020
Mier-Martínez M, García-Benítez L, Santiago-Vázquez V. Tamiz cardiológiconeonatal en México. Estudio multicéntrico. En: VI Congreso Nacionalde la Asociación Mexicana de Especialistas en Cardiopatías Congénitas(AMECC2021); 2021 jun 10-12; Los Cabos (BCS), México.
WHO Commission on Macroeconomics and Health & World HealthOrganization. Macroeconomía y salud: invertir en salud en pro deldesarrollo económico: informe de la Comisión sobre Macroeconomía ySalud. Sinopsis. Ginebra: OMS, 2001 [citado abril 10, 2022]. Disponible en:https://apps.who.int/iris/handle/10665/42465
Hoke TR, Donohue PK, Bawa PK, Mitchell RD, Pathak A, Rowe PC,et al. Oxygen saturation as a screening test for critical congenital heartdisease: a preliminary study. Pediatr Cardiol. 2002;23(4):403-9. https://doi.org/10.1007/s00246-002-1482-8
Knowles R, Griebsch I, Dezateux C, Brown J, Bull C, Wren C. Newbornscreening for congenital heart defects: a systematic review and costeffectivenessanalysis. Health Technol Assess. 2005;9(44):1-152. https://doi.org/10.3310/hta9440
González-Andrade F. High altitude as a cause of congenital heartdefects: a medical hypothesis rediscovered in Ecuador. High Alt Med Biol.2020;21(2):126-34. https://doi.org/10.1089/ham.2019.0110
Reeder MR, Kim J, Nance A, Krikov S, Feldkamp ML, Randall H, et al.Evaluating cost and resource use associated with pulse oximetry screeningfor critical congenital heart disease: empiric estimates and sourcesof variation. Birth Defects Res A Clin Mol Teratol. 2015;103(11):962-71.https://doi.org/10.1002/bdra.23414
Peterson C, Dawson A, Grosse S, Riehle-Colarusso T, Olney R, TannerJ, et al. Hospitalizations, costs, and mortality among infants with criticalcongenital heart disease: how important is timely detection? Birth DefectsRes A Clin Mol Teratol. 2013;97(10):664-72. https://doi.org/10.1002/bdra.23165
Kochilas LK, Lohr JL, Bruhn E, Borman-Shoap E, Gams BL, PylipowM, et al. Implementation of critical congenital heart disease screening inMinnesota. Pediatrics. 2013;132(3):e587-e594. https://doi.org/10.1542/peds.2013-0803
Woods B, Revill P, Sculpher M, Claxton K. Country-level cost-effectivenessthresholds: initial estimates and the need for further research. ValueHealth. 2016;19(8):929-35. https://doi.org/10.1016/j.jval.2016.02.017