OBJECTIVES: Critical congenital heart diseases, such as late postnatal diagnosis, are associated with the prognosis of surgical treatment or catheterization before the first year of life, as well as with more hospital admissions, more hospital days, and more hospital costs during childhood. This research aims to establish the incremental cost-effectiveness ratio of cutaneous pulse oxymetry at 24 hours after birth, in addition to the general examination of the newborn, in the early detection of critical congenital heart disease in Colombia.

METHODS: A full cost-effectiveness analysis was conducted from a societal perspective using a decision tree that compares general examination plus pulseoximetry versus the general examination only to detect critical congenital heart disease. Sensitivity and specificity of the test were taken from the best evidence available through a systematic review; costs were estimated using official sources and local rates. For non-dominated alternatives we calculated the incremental cost-effectiveness ratio and we performed a deterministic sensitivity analysis to assess the effect of uncertainty.

RESULTS: The cost of screening with pulse oximetry and general examination was USD 124, USD 30 more than the general examination alone; the effectiveness of pulse oximetry and general examination was 0.99, 0.01 more than general examination alone. The incremental cost-effectiveness ratio was estimated at USD 3,008 per correctly diagnosed cases, that is, if we want to increase the number of correctly diagnosed cases by 1%, that amount will have to be invested. Willingness to pay was defined at USD 5,138.42 per case correctly diagnosed. Results were sensitive to changes in specificity of the tests and prevalence of critical congenital heart disease.

CONCLUSIONS: From the societal point of view and at current prices, 24-hour pulse oximetry screening in addition to general newborn screening may be a cost-effective strategy for the early detection of critical congenital heart disease in Colombia.