Financial justification for routine ultrasound screening of the neonatal hip

Clegg, J.; Bache, C. E.; Raut, Videsh

doi:10.1302/0301-620x.81b5.0810852

Cited by 36 publications

(30 citation statements)

References 23 publications

(31 reference statements)

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“…This study shows higher initial costs caused by the ultrasound screening, but also a significant reduction in the total number and overall costs of dysplastic hips undergoing operative and non-operative treatment. Similar findings were reported by Clegg et al, 22 who compared the surgical costs of three screening methods for DDH: universal clinical examination alone, universal clinical examination with selective ultrasound examination for newborn babies with risk factors, and universal ultrasound screening. The mean costs per 1000 live births were £5110 for clinical investigation alone, £3811 for selective ultrasound screening, and £468 for universal ultrasound screening.…”

Section: Discussionsupporting

confidence: 84%

“…14 There is little published data concerning cost analysis when comparing clinical examination alone with clinical examination and ultrasound screening. [20][21][22] In the Austrian province of Tyrol, clinical examination alone was performed between 1978 and 1982. Between 1983 and 1988, a nationwide ultrasound screening programme according to Graf 6 was developed throughout Austria and since 1988 ultrasound screening has been performed for all newborn babies.…”

mentioning

confidence: 99%

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Cost-effectiveness of universal ultrasound screening compared with clinical examination alone in the diagnosis and treatment of neonatal hip dysplasia in Austria

Thaler

Biedermann

Lair

et al. 2011

The Journal of Bone and Joint Surgery. British volume

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Between 1978 and 1997 all newborns in the Austrian province of Tyrol were reviewed regarding hip dysplasia and related surgery. This involved a mean of 8257 births per year (7766 to 8858). Two observation periods were determined: 1978 to 1982 (clinical examination alone) and 1993 to 1997 (clinical examination and universal ultrasound screening). A retrospective analysis compared the number and cost of interventions due to hip dysplasia in three patient age groups: A, 0 to < 1.5 years; B, ≥ 1.5 to < 15 years; and C, ≥ 15 to < 35 years. In group A, there was a decrease in hip reductions from a mean of 25.2 (SD 2.8) to 7.0 (SD 1.4) cases per year. In group B, operative procedures decreased from a mean of 17.8 (SD 3.5) to 2.6 (SD 1.3) per year. There was a 75.9% decrease in the total number of interventions for groups A and B. An increase of €57,000 in the overall cost per year for the second period (1993 to 1997) was seen, mainly due to the screening programme. However, there was a marked reduction in costs of all surgical and non-surgical treatments for dysplastic hips from €410,000 (1978 to 1982) to €117,000 (1993 to 1997). We believe the small proportional increase in costs of the universal ultrasound screening programme is justifiable as it was associated with a reduction in the number of non-surgical and surgical interventions. We therefore recommend universal hip ultrasound screening for neonates.

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Section: Discussionsupporting

confidence: 84%

mentioning

confidence: 99%

Cost-effectiveness of universal ultrasound screening compared with clinical examination alone in the diagnosis and treatment of neonatal hip dysplasia in Austria

Thaler

Biedermann

Lair

et al. 2011

The Journal of Bone and Joint Surgery. British volume

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“…As regards risk factors, females with a positive family history, and especially those born in the breech presentation, seem to have the highest risks. It is accepted that, scanning at birth, there will be numerous morphologically immature or unstable hips identified that will resolve spontaneously [139,145,146,147,148]. That is why we agree with authors who propose to postpone US in unselected infants beyond the neonatal period [145,149,150].…”

Section: Musculoskeletal Systemsupporting

confidence: 76%

Paediatric ultrasound. Part 2: Other applications

Tomà

Rossi

2001

Eur Radiol

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This article focuses on small-parts US in children. The differential diagnosis of cystic neck masses primarily includes lymphangiomas, thyroglossal duct cysts and branchial cleft cysts. Solid masses may be represented from lymphadenopathies, cervical extensions of mediastinal thymus, fibromatosis colli, rhabdomyosarcomas and neuroblastomas. Salivary gland lesions are uncommon in children. Thyroid is best evaluated by US and nuclear scintigraphy. If US shows abnormal thyroid gland, the isotopic scan may be a good complementary method to confirm the diagnosis. Normal parathyroid glands are not visualised routinely by US because of their small size. Parathyroid adenomas are unusual in paediatrics. Ultrasound can be successfully used in the differential diagnosis of the painful scrotum especially with colour flow Doppler. The hallmark of ischaemia is a completely avascular testis. In the paediatric age group, the most common application of US to the musculoskeletal system is the evaluation of the infant hip in the first 6 months of life; however, the refinement of new transducers has further improved the ability of US equipment to evaluate a variety of other musculoskeletal disorders in children, involving tendons, muscles, nerves as well as soft tissue masses. Ultrasound can be a useful screening tool in newborns suspected of having closed spinal dysraphism.

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“…Gray et al [18] calculated that in the sonography group the overall costs per patient were $190 less than those in the non-sonography group, but could not prove statistical significance. Clegg et al [8] [15,19,41] that document a significant reduction of treatment costs with a moderate increase of diagnostic expenses. The calculations on the overall financial burden of the Austrian Public Health System seem to decrease over the time.…”

Section: Discussionmentioning

confidence: 99%

Developmental dysplasia of the hip: Impact of sonographic newborn hip screening on the outcome of early treated decentered hip joints—a single center retrospective comparative cohort study based on Graf's method of hip ultrasonography

Tschauner¹,

Fürntrath²,

Saba

et al. 2011

Journal of Children's Orthopaedics

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Compared to the era before the institution of a sonographic hip screening programme according to the Graf-method in Austria in 1992, ultrasound screening based-treatment of decentered hip joints has become safer, shorter and simpler: "safer" means lower rate of AVN, "shorter" means less treatment time due to earlier onset and "simpler" means that the devices are now less invasive and highly standardized.

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Financial justification for routine ultrasound screening of the neonatal hip

Abstract: When we add the cost of running the screening programme to the expense of treating the condition, the overall cost for the management of DDH is comparable for the different screening policies. [Br] 1999;81-B:852-7. J Bone Joint Surg

Cited by 36 publications

References 23 publications

Cost-effectiveness of universal ultrasound screening compared with clinical examination alone in the diagnosis and treatment of neonatal hip dysplasia in Austria

Cost-effectiveness of universal ultrasound screening compared with clinical examination alone in the diagnosis and treatment of neonatal hip dysplasia in Austria

Paediatric ultrasound. Part 2: Other applications

Developmental dysplasia of the hip: Impact of sonographic newborn hip screening on the outcome of early treated decentered hip joints—a single center retrospective comparative cohort study based on Graf's method of hip ultrasonography

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