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. 2020 Oct;111(5):804-811.
doi: 10.17269/s41997-019-00280-7. Epub 2020 Jan 6.

Pulse oximetry screening for critical congenital heart defects in Ontario, Canada: a cost-effectiveness analysis

Amit Mukerji  1 , Amy Shafey  2 , Amish Jain  3 , Eyal Cohen  3   4 , Prakesh S Shah  3   4 , Beate Sander  4   5 , Vibhuti Shah  3   4
Affiliations

Pulse oximetry screening for critical congenital heart defects in Ontario, Canada: a cost-effectiveness analysis

Amit Mukerji et al. Can J Public Health. 2020 Oct.

Abstract
in English, French

Objective: Previously conducted cost-effectiveness analyses of pulse oximetry screening (POS) for critical congenital heart defects (CCHDs) have shown it to be a cost-effective endeavour, but the geographical setting of Ontario in relation to its vast yet sparsely populated regions presents unique challenges. The objective of this study was to estimate the cost-effectiveness of POS for CCHD in Ontario, Canada.

Methods: A cost-effectiveness analysis, comparing POS to no POS, was conducted from the Ontario healthcare payer perspective using a Markov model. The base case was defined as a well-appearing newborn at 24 h of age. Outcome measures, including quality-adjusted life months (QALMs), lifetime costs, and incremental cost-effectiveness ratios (ICER) [ΔCost/ΔQALMs], were calculated over a lifetime horizon. All outcomes were discounted at 1.5% per year. Cost-effectiveness was assessed using an a priori ICER threshold of CAD$4166.67 per QALM (equivalent to CAD$50,000 per quality-adjusted life year). Deterministic and probabilistic sensitivity analyses were conducted to assess parameter uncertainty.

Results: Implementation of POS is expected to lead to timely diagnosis of 51 CCHD cases annually. The incremental cost of performing POS was estimated to be $27.27 per screened individual, with a gain of 0.02455 QALMs. This yielded an ICER of CAD$1110.79 per QALM, well below the pre-determined threshold. The probabilistic sensitivity analysis estimated a 92.3% chance of routine implementation of POS being cost-effective.

Conclusion: Routine implementation of POS for CCHD in Ontario is expected to be cost-effective.

Objectif: Les analyses coût-efficacité du dépistage par oxymétrie de pouls (DOP) des cardiopathies congénitales critiques (CCC) menées antérieurement ont montré que c’est une technique efficace par rapport à son coût, mais l’emplacement géographique de l’Ontario, avec ses vastes régions à faible densité de population, présente des difficultés particulières. Nous avons donc cherché à estimer le rapport coût-efficacité du DOP des CCC en Ontario, au Canada.

Méthode: Une analyse coût-efficacité comparant le DOP à l’absence de DOP a été menée selon la perspective des contribuables payant pour les soins de santé en Ontario à l'aide d’un modèle de Markov. Le scénario de référence était celui d’un nouveau-né apparemment bien portant âgé de 24 heures. Les indicateurs de résultat, dont les mois de vie pondérés par la qualité (MVPQ), les coûts à vie et les rapports coût-efficacité différentiels (RCED) [ΔCoût / ΔMVPQ], ont été calculés pour l’horizon temporel de la vie entière. Tous les résultats ont été actualisés à 1,5 % par année. L’efficacité par rapport au coût a été évaluée a priori à l'aide d’un seuil de RCED de 4 166,67 $CAN par MVPQ (équivalant à 50 000 $CAN par année de vie pondérée par la qualité). Des analyses de sensibilité déterministes et probabilistes ont été menées pour évaluer l’incertitude des paramètres.

Résultats: La mise en œuvre du DOP devrait mener au diagnostic opportun de 51 cas de CCC par année. Le coût différentiel du DOP était estimé à 27,27 $ par personne dépistée, avec un gain de 0,02455 MVPQ. Cela donne un RCED de 1 110,79 $CAN par MVPQ, très en-deçà du seuil prédéterminé. L’analyse de sensibilité probabiliste a estimé à 92,3 % la probabilité que la mise en œuvre systématique du DOP soit efficace par rapport au coût.

Conclusion: On peut s’attendre à ce que la mise en œuvre systématique du DOP pour les CCC en Ontario soit efficace par rapport au coût.

Keywords: Cost-effectiveness threshold; Cost-utility analysis; Health economics; Saturation screening; Utility.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Illustration of decision tree during first Markov cycle and various possible outcomes (including need for transfers) in a simulated individual who has CCHD
Fig. 2
Fig. 2
Panel a illustrates possible outcomes after missed CCHD incorporated into first cycle of Markov decision model. Panel b shows the possible outcomes of CCHD surgery incorporated into first cycle of Markov model. Note than in both Figs. 1 and 2, the circles represent a “chance” node with a certain probability associated with either arm emanating from that node being chosen (determined by the values for probabilities inputted into the model) while the triangles represent a “terminal” node, culminating in the transition to another health state
Fig. 3
Fig. 3
Illustration of the possible transitions (denoted by arrows) among the 4 health states in subsequent Markov cycles
Fig. 4
Fig. 4
Cost-effectiveness scatter plot. Note: Each dot represents the incremental cost and incremental effectiveness (QALM) from each simulation, and all simulation values “below” the line of cost-effectiveness threshold are deemed to be cost-effective, whereas the ones above the threshold line represent simulations where ICER for POS implementation was above the pre-determined threshold value
Fig. 5
Fig. 5
Cost-effectiveness acceptability at various cost-effectiveness (or “willingness to pay”) thresholds
See this image and copyright information in PMC

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