Cost Analysis of Screening Programmes for Developmental Dysplasia of the Hip: A Systematic Review

Abstract

Aims The aim of this study was to assess screening costs in developmental dysplasia of the hip (DDH), to provide any clarity on the cost-effectiveness of various hip screening programmes internationally. Methods A PROSPERO-registered systematic review was performed by examining cost analysis studies of various DDH screening programmes, including those based around clinical examination, selective ultrasound and universal ultrasound. Costs were analysed using narrative synthesis. Results There were 14 studies included in this review. Two studies found that clinical hip screening is advantageous over no screening at all, both in terms of overall cost and favourable outcomes. When considering selective ultrasound imaging versus clinical screening, two studies found it to be more expensive, one found it cheaper and three studies calculated the overall programme costs to be similar. With universal ultrasound, four studies calculated this to be cheaper than clinical or selective ultrasound screening due to a reduced late detection and surgery rate. However, a comparable number of studies concluded that the increased financial costs of universal ultrasound were greater than the reduction in surgical costs. No studies included any long-term data. Conclusion There is a dearth of information on DDH screening costs, with significant heterogeneity amongst the existing literature. Future research should include the cost analysis of long-term complications of DDH, including the social and psychological impact of early onset arthritis, as well as gender specific ultrasound screening programmes.

Active monitoring versus immediate abduction as treatment of stable developmental dysplasia of the hip: a systematic review of the literature

“…7 A third screening method is universal screening including clinical examination only. 10 Existing literature comparing screening methods is scant and shows methodological heterogeneity. 7 Limitations of clinical examination alone are the lower sensitivity, difficulty to identify subtle signs and the majority of positive Ortolani or Barlow manoeuvres will spontaneously resolve within 2-4 weeks after birth.…”

“…Limitations of clinical examination alone are the lower sensitivity, difficulty to identify subtle signs and the majority of positive Ortolani or Barlow manoeuvres will spontaneously resolve within 2–4 weeks after birth. 10 11 Ultrasonography according to the Graf method is one of the most used methods to diagnose and classify DDH. 12 13 The Graf method classifies type two hips as stable but dysplastic hips and type three hips as unstable or luxated hips.…”

“…The timing of ultrasound screening ranges from week 1 to week 12 7. A third screening method is universal screening including clinical examination only 10. Existing literature comparing screening methods is scant and shows methodological heterogeneity 7…”

The management of developmental dysplasia of the hip in children aged under three months

“…3,4,[22][23][24][25][26][27] This, however, has the potential for overtreatment and increased costs. 6,22,[28][29][30] Some bodies, including the U.S. Preventative Services Task Force, do not recommend any screening. 31 The evidence giving rise to these differences is clearly insufficient.…”

Hip and Happening: Current Concepts in the Diagnosis and Management of Developmental Dysplasia of the Hip in 2022

“…18 years later, we still do not have an infant hip screening programme that is uniformly implemented across the country. Two systematic reviews by Pandey & Johari [4] and Harper et al [5] in this issue analyse the effectiveness and cost analysis of various screening programmes for DDH utilized globally, while a thought-provoking editorial by Prof. Ashok Johari highlights the multipronged approach required to develop a National DDH screening programme to overcome the challenges of lack of awareness, access, knowledge, competence, resources & legislation that are endemic to India's healthcare system [6]. Accordingly, the Paediatric Orthopaedic Society of India (POSI) recently partnered with seven national organizations in developing screening guidelines and a DDH care pathway that are contextual to the healthcare system in India.…”