Key Findings: Hospital costs of newborn screening for critical congenital heart defects

The journal Public Health Reports has published a new study on the costs of hospital newborn screening for critical congenital heart defects (CCHD) in New Jersey. In this study, CDC researchers estimated that the hospital cost for CCHD screening is comparable to existing newborn screenings for hearing and metabolic conditions. The type of screening equipment that hospitals use can have a large impact on hospital costs. These findings might be useful for states that are considering newborn screening for CCHD. You can read the article’s abstract here

Main Findings from this Study

This study estimated hospitals' time and cost to screen newborns for CCHD using pulse oximetry, a simple bedside test to determine the amount of oxygen in a newborn’s blood.

CCHD screening took about nine minutes per newborn in well-baby nurseries and seven minutes per newborn in special or intensive care nurseries.
CCHD screening cost an estimated $14.19 per newborn ($7.36 for labor and $6.83 for equipment; 2011 US dollars)
- Screening in well-baby nurseries cost $14.09 per newborn, compared to $14.70 in special or intensive care nurseries.
These cost estimates do not include follow-up costs, such as testing to diagnose the type of CCHD, or other costs, such as cost of education and training materials for nurses that perform the screening.
CCHD screening costs were much lower with reusable, as opposed to disposable, screening equipment.
- The lowest screening cost was for one hospital that used reusable sensors. Their average equipment cost was $0.49 per newborn.
- In contrast, among three hospitals using disposable sensors to screen healthy newborns, the average equipment cost was $13.65 per newborn.

Basics about Critical Congenital Heart Defects

What are critical congenital heart defects?Congenital heart defects are the most common type of birth defect in the United States, affecting nearly 1% of―or about 40,000―births per year. About 1 in 4 babies born with a heart defect has a critical congenital heart defect (CCHD, also known as critical congenital heart disease).1 Babies with a CCHD need surgery or other procedures within the first year of life.

How can newborn screening help babies with CCHD?Some babies born with a CCHD appear healthy at first and can be sent home before their heart defect is detected. These babies are at risk of having serious complications within the first few days or weeks of life and often require emergency care. Newborn screening can identify some of these babies so they can receive care and treatment that can help prevent disability or early death.

Newborn screening for CCHD involves a simple bedside test to determine the amount of oxygen in a baby’s blood. Low levels of oxygen in the blood can be a sign of CCHD. CCHD screening has begun in some states, and laws requiring this screening have been proposed or passed in other states. You can see what is happening in your state here.

About this Study

In a randomly selected sample of seven hospitals in New Jersey, researchers timed 23 newborns being screened for CCHD using pulse oximetry. They also surveyed hospital administrators to estimate screening costs.

More Information

To learn more about congenital heart defects, please visithttp://www.cdc.gov/heartdefects/.

To learn more about screening for critical congenital heart defects, please visit http://www.cdc.gov/ncbddd/pediatricgenetics/CCHDscreening.html.

Paper Reference

Peterson C, Grosse SD, Glidewell J, Garg LF, Van Naarden Braun K, Knapp MM, Beres LM, Hinton CF, Olney RS, Cassell CH. Costs of hospital newborn screening in New Jersey to detect critical congenital heart disease. Public Health Reports. 2013 [epub ahead of date]

Heart Defects: CDC Activities

Centers for Disease Control and Prevention (CDC) works to identify causes of congenital heart defects (CHDs) and ways to prevent them. We do this through:

Surveillance or disease tracking:
1. State programs: CDC funds and coordinates the Metropolitan Atlanta Congenital Defects Program (MACDP). CDC also funds 14 population-based state tracking programs. Birth defects tracking systems are vital to help us find out where and when birth defects occur and whom they affect.
2. Adolescents and adults: CDC recently funded 3 projects to track congenital heart defects among adolescents and adults in order to learn about their health issues and needs across the lifespan.
Research: CDC funds a large study of birth defects called the National Birth Defects Prevention Study . This study is working to identify risk factors for birth defects, including heart defects.
Collaboration:
1. CDC is assessing states’ needs for help with CCHD screening and reporting of screening results. CDC worked with New Jersey and Georgia to assess their ability to track CCHD screening. CDC is also helping states and hospitals to better understand how much hospitals spend for each baby screened.
2. CDC promotes collaboration between birth defects tracking programs and newborn screening programs for CCHD screening activities. State birth defects programs collect data on CHDs and could help evaluate the effectiveness of screening by looking at false positives (babies who failed the CCHD screening but do not actually have a CCHD after further evaluation) and false negatives (babies who passed the screen suggesting there was no CCHD but actually did have a CCHD).
3. CDC provides technical assistance to the Congenital Heart Public Health Consortium and to states receiving funding from the Health Resources and Services Administration (HRSA) for CCHD screening activities.

References

Oster M, Lee K, Honein M, Colarusso T, Shin M, Correa A. Temporal trends in survival for infants with critical congenital heart defects. Pediatrics. 2013; 131(5):e1502-8.