Table 6.
Summary of screening results in second-order Monte Carlo simulations of 10000 low-risk mothers
| Screening strategy | Total cost (× 106) |
Effectiveness (n (%) of cases detected)* |
Average CE |
Incremental cost |
Incremental effectiveness (%) |
ICER ($/cases detected) |
|---|---|---|---|---|---|---|
| 4C → MFM | $1.70 | 24 (34) | $71 701 | $10 005 | −12 (−30) | Dominated† |
| 4C → card | $1.72 | 30 (43) | $57 774 | $23 994 | −6 (−22) | Dominated† |
| 4C + outflow → MFM (Ref) | $1.69 | 36 (51) | $47 268 | — | — | — |
| 4C + outflow → card | $1.70 | 45 (64) | $37 885 | $5168 | 9 (13) | $574 |
| MFM 4C + outflow → card | $2.17 | 51 (73) | $42 548 | $471672 | 15 (21) | $31 320 |
| NT + outflow | $3.17 | 52 (74) | $61 889 | $1 472 634 | 15 (21) | Extended dominance‡ |
| Fetal echo | $5.14 | 66 (94) | $77 907 | $3 443 591 | 30 (43) | $114367 |
*
Assuming an incidence of congenital heart disease (CHD) of 0.007 per live birth and 70 cases of CHD in this cohort.
†
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; CE, cost effectiveness; Fetal echo, fetal echocardiography; ICER, incremental cost-effectiveness ratio; MFM, maternal–fetal medicine specialist; NT, nuchal translucency; Ref, reference.