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

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Abstract

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.

Résumé

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.

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Acknowledgements

We would like to acknowledge Ms. Laura Banfield, MSc, for devising the literature searches, and Drs. Tapas Mondal, Michael Marrin, Stephanie Redpath, Henry Roukema, Catalina Tamayo, Michael Castaldo, Ms. Lynda Aliberti, Ms. Amuna Yacob and Ms. Julie Alyssandratos-Amatuzio for providing data (institutional affiliations and data provided detailed in Supplemental File 2). Finally, we would like to acknowledge Ms. Carrie-Ann Whyte, Senior Analyst, Canadian Institute for Health Information, and Ms. Catherine Riddell, Data request and research coordinator, Better Outcomes Registry and Network, for providing custom-requested data.

Author information

Author notes

  1. Beate Sander and Vibhuti Shah are joint senior authors.

Authors and Affiliations

  1. Department of Pediatrics, McMaster University, Hamilton, ON, Canada

    Amit Mukerji

  2. Department of Pediatrics, University of Calgary, Calgary, AB, Canada

    Amy Shafey

  3. Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    Amish Jain, Eyal Cohen, Prakesh S. Shah & Vibhuti Shah

  4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Eyal Cohen, Prakesh S. Shah, Beate Sander & Vibhuti Shah

  5. Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada

    Beate Sander

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  1. Amit Mukerji
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Corresponding author

Correspondence to Amit Mukerji.

Ethics declarations

This study was approved by the Research Oversight and Compliance Office - Human Research Ethics Program, University of Toronto, protocol reference number 32846.

Conflict of interest

The authors declare that they have no conflicts of interest.

Disclosure

Data from this study were presented at Pediatric Academic Societies Conference 2018 (Toronto, Canada). This work was part of the requirements for completion of a Master of Science degree in clinical epidemiology at the Institute for Health Policy, Management and Evaluation, University of Toronto, for A.M. The primary author (A.M.) is a recipient of an early career award from Hamilton Health Sciences Foundation (2019–2021) to support his research, although it did not directly impact the conduct of this study.

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Mukerji, A., Shafey, A., Jain, A. et al. Pulse oximetry screening for critical congenital heart defects in Ontario, Canada: a cost-effectiveness analysis. Can J Public Health 111, 804–811 (2020). https://doi.org/10.17269/s41997-019-00280-7

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  • DOI: https://doi.org/10.17269/s41997-019-00280-7

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