Table 3.

Cost-effectiveness base–case analysis for prenatal screening of congenital heart disease (CHD)

Strategy	Cost	Incremental cost	Effectiveness* (cases detected per 1000)	Incremental effectiveness (per 1000)	ICER	Cases found† (%)
4C + outflow → MFM	$169.33	—	3.53	—	—	50.0
4C + outflow → card	$169.84	$0.51	4.42	0.9	$579	63.1
4C → MFM	$170.37	$1.04	2.37	−1.16	Dominated‡	33.9
4C → card	$171.76	$2.43	2.96	−0.57	Dominated‡	42.4
MFM 4C + outflow → card	$216.53	$47.20	5.07	1.54	$30 591	72.5
NT + outflow	$316.58	$147.25	5.06	1.53	Extended dominance§	72.4
Fetal echo	$513.72	$344.39	6.59	3.06	$112 560	94.2

^*Effectiveness is the population likelihood of a true-positive diagnosis.

^†Cases found represents the effectiveness/population likelihood of CHD (assumed incidence is seven per 1000 births).

^‡A strategy is dominated when it is more costly and less effective than the strategy to which it is being compared.

^§A strategy is dominated by extended dominance when a combination of two other strategies is less expensive and more effective. 4C, four-chamber view; 4C+ outflow, four-chamber and outflow-tract views; card, pediatric cardiologist; Fetal echo, fetal echocardiography; ICER, incremental cost-effectiveness ratio; MFM, maternal–fetal medicine specialist; NT, nuchal translucency.