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EE310 Cost-Effectiveness of the Prenatal Detection of Congenital Heart Diseases: A Systematic Literature Review

2022; Elsevier BV; Volume: 25; Issue: 12 Linguagem: Inglês

10.1016/j.jval.2022.09.557

1524-4733

D Londoño, Peter Abrante de Castro, K. Rojas, Karen Moreno, MT Alonso Dominguez, Rodolfo Dennis, Norma Gómez Sandoval, Miguel Ronderos,

Congenital Heart Disease Studies

To identify the cost-effectiveness ratio of diagnostic imaging for the detection of congenital heart disease during the gestational period, reported in the world literature between 1995 and 2020. Systematic review applying the Preferred Reporting Items for Systematic reviews and Meta-Analyses - PRISMA and Consolidated Health Economic Evaluation Reporting Standards -CHEERS guidelines for economic evaluations. Inclusion and exclusion criteria were determined. Quantitative synthesis was performed by type of economic evaluation. The methodological robustness of the articles included in the evidence synthesis was evaluated. Incremental costs and effectiveness were compiled and compared, as well as the cost-effectiveness ratio of each study. We found 785 articles of which only seven met all the inclusion criteria. In most cases it was a cost-effectiveness analysis and the most frequent outcome was the number of cases detected. In the case of routine ultrasound in the first trimester of gestation referred by a maternal-fetal health specialist, it was the least costly strategy per defect detected. The 4C and nuchal translucency views were dominated by other strategies, which that means, both strategies are more costly and less effective. Fetal echocardiography was the most effective but is the most expensive. In some studies, with the simulation of 10,000 low-risk pregnancies, 4C outflow detection referred to a specialist remained the least expensive per defect detected, with this strategy being recommended. The systematic review process showed that the most commonly used outcomes are cases detected, QALYs and costs avoided. The source of effectiveness is, in general, the literature review, and the use of direct and indirect medical costs is recommended. Finally, the type of economic evaluation model referenced is the decision tree. Most of the studies recommend the implementation of ultrasonography.