The cost effectiveness of potential risk factors for developmental dysplasia of the hip within a national screening programme.

Autor:	Poacher AT; Trauma Department, University Hospital of Wales, Cardiff, UK., Froud JLJ; Guy's and St Thomas' NHS Foundation Trust, London, UK., Caterson J; London North West NHS Trust, London, UK., Crook DL; Department of Surgery, Royal London Hospital, London,, UK., Ramage G; Cardiff University School of Medicine, Cardiff, UK., Marsh L; Cardiff University School of Medicine, Cardiff, UK., Poacher G; Ability Medical Education, Cardiff, UK., Carpenter EC; Noah's Ark Children's Hospital for Wales, Cardiff, UK.
Jazyk:	angličtina
Zdroj:	Bone & joint open [Bone Jt Open] 2023 Apr 03; Vol. 4 (4), pp. 234-240. Date of Electronic Publication: 2023 Apr 03.
DOI:	10.1302/2633-1462.44.BJO-2022-0135.R1
Abstrakt:	Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate a novel screening programme that included both the primary risk factors of breech presentation and family history, and the secondary risk factors of oligohydramnios and foot deformities. A five-year prospective registry study investigating every live birth in the study's catchment area (n = 27,731), all of whom underwent screening for risk factors and examination at the newborn and six- to eight-week neonatal examination and review. DDH was diagnosed using ultrasonography and the Graf classification system, defined as grade IIb or above or rapidly regressing IIa disease (≥4 o at four weeks follow-up). Multivariate odds ratios were calculated to establish significant association, and risk differences were calculated to provide quantifiable risk increase with DDH, positive predictive value was used as a measure of predictive efficacy. The cost-effectiveness of using these risk factors to predict DDH was evaluated using NHS tariffs (January 2021). The prevalence of DDH that required treatment within our population was 5/1,000 live births. The rate of missed presentation of DDH was 0.43/1000 live births. Breech position, family history, oligohydramnios, and foot deformities demonstrated significant association with DDH (p < 0.0001). The presence of breech presentation increased the risk of DDH by 1.69% (95% confidence interval (CI) 0.93% to 2.45%), family history by 3.57% (95% CI 2.06% to 5.09%), foot deformities by 8.95% (95% CI 4.81% to 13.1%), and oligohydramnios nby 11.6% (95 % CI 3.0% to 19.0%). Primary risk factors family history and breech presentation demonstrated an estimated cost-per-case detection of £6,276 and £11,409, respectively. Oligohydramnios and foot deformities demonstrated a cost-per-case detected less than the cost of primary risk factors of £2,260 and £2,670, respectively. The inclusion of secondary risk factors within a national screening programme was clinically successful as they were more cost and resource-efficient predictors of DDH than primary risk factors, suggesting they should be considered in the national guidance. Competing Interests: The authors confirm that they have no conflicting interests to declare. (© 2023 Author(s) et al.)
Databáze:	MEDLINE
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