HIP trial: Economic evaluation of ultrasound management of neonatal hip instability
|Funding:||Department of Health and Medical Research Council|
|Collaborators:||National Perinatal Epidemiology Unit, University of Oxford|
The prevalence at birth of congenital dislocation of the hip has been estimated in Northern Europe at approximately one per 1000. In the UK, a universal screening policy has been in place since 1969, based on clinical examination using the Ortolani-Barlow test to detect dislocated or dislocatable hips within 48 hours of birth, at discharge from hospital and at 6 weeks of age. The effectiveness of this policy has not been proven, with concern that false positives may generate unnecessary treatment (primarily splinting) or that false negatives may delay treatment and be associated with more serious interventions such as surgery. In recent years, the use of ultrasound examination has diffused, and universal primary ultrasound screening has been adopted in some European countries. However, the evidence for this is also uncertain.
In light of the above uncertainties, the Department of Health commissioned a multi-centre randomised controlled trial to assess the effectiveness and cost-effectiveness of ultrasound in the management of infants with clinically detected hip instability. The principal outcome measure of the study is a functionally normal hip at 2 years of age as established by x-ray. Cost-effectiveness is expressed as a net cost per functionally normal hip at age 2.
The main items included in the costings are:
- Health service costs - resource volumes are collected from the trial data collection sheets, and unit costs are then attached to these volumes using data supplied by participating centres;
- Family costs - these are collected via a baseline questionnaire on household characteristics, and a 6-monthly questionnaire to all parents of babies currently in the trial, covering cost-generating events over the previous 4 weeks.
Elbourne D, Dezateux C, Arthur R, Clarke NMP, Gray AM , King A, Quinn A, Gardner F, Russell G on behalf of the UK Collaborative Hip Trial Group. Ultrasonography in the Diagnosis and Management of Developmental Hip Dysplasia (UK Hip Trial): Clinical and Economic Results of a Multicentre Randomised Controlled Trial. The Lancet 2002; 360:2009-17