A UK study found that neonatal clinical examination detected 90 cases of clinically significant congenital heart disease per 100 000 infants screened and that this could be increased to 120 per 100 000 by screening using pulse oximetry. Just because it is possible to detect more pathology does not mean we should always do so. Money spent on routine pulse oximetry might be spent better on another more cost-effective health-care intervention. An economic evaluation found that the incremental cost-effectiveness ratio for pulse oximetry plus clinical examination compared with clinical examination alone was £24 000 (about $36 000) per case of timely diagnosis, a figure that if robust would normally be considered cost-effective. Screening initiatives should be tested for cost-effectiveness before they are introduced widely.
Reviewer: David Isaacs, firstname.lastname@example.org