Screening for congenital dislocation of the hip: an economic appraisal.

The direct costs of screening for congenital dislocation of the hip (CDH) are compared with the treatment costs resulting from no screening in a cost-effectiveness analysis in British Columbia. Under certain conditions the costs associated with screening and subsequent conservative treatment for 6 to 15 positive cases of CDH/1000 liveborn infants were considerably lower than the costs of either open or closed reduction of the hip for 1.5 infants with CDH per 1000 infants not screened. When adjustments were made to the assumptions about screening costs, rates with which cases were missed and hospital treatment costs, only the assumptions thought to be overly unfavourable to screening and overly optimistic for no screening brought the costs of no screening within the likely range of costs of screening. Some specific and general implications of the cost-effectiveness of screening for CDH in British Columbia are discussed.