Original Title: Efectividad y coste-efectividad de los programas de vigilancia para prevenir la luxación de cadera en parálisis cerebral

Authors' objectives: • To review the effectiveness of surveillance and early intervention programs to prevent hip dislocation in children and adolescents with cerebral palsy. • To determine the cost-effectiveness of a surveillance program of early detection and intervention in children with cerebral palsy, compared to not establish such a program and perform the identification according to routine clinical practice.

Authors' results and conclusions: RESULTS: Three articles reporting on two retrospective studies (whose intervention groups were overlapped) were included. The assessment of the evidence was based on the study Hägglund et al. (2014), which showed a significant reduction in dislocation rate (RR = 0.03; 95% CI .01-.15) 20 years after the implementation of the program. There were no significant differences in the number of operations or operated children. No results on pain or quality of life were reported. No economic evaluation was identified. As for the economic evaluation, program monitoring and early intervention has been more effective and more costly than routine clinical practice. The cost per QALY was estimated at 6,500 € per QALY, a value that is significantly below the reference dispocisión to pay, and therefore the program was considered as cost-effective. The sensitivity analysis indicates that for a willingness to pay of 25,000 € / QALY, the probability that the program is cost-effective is around 60%, which shows that there is a relatively high level of uncertainty. CONCLUSIONS: The evidence obtained on the effectiveness of surveillance programs to prevent hip dislocation in cerebral palsy is of low quality. However, it has been considered that the potential benefit of such programs, even without reaching such an intense effect as seen in the included studies, reasonably outweigh the potential risks arising from its implementation. In any case, we highlighted a number of aspects (organizational, ethical and related to the current evidence on the effectiveness of preventive treatments) that could adversely affect the expected results, and therefore must be carefully evaluated before the implementation of a program of this nature. The developed economic model is robust to changes in the assumptions applied, and shows that the program has a good chance of being cost-effective.

Authors' recommendations: A conditional recommendation in favor of the introduction of a monitoring program for the prevention of hip dislocation in children and adolescents with cerebral palsy recommendation was established. The conditionality of the recommendation refers to the low quality of the evidence and the need for adequate prior assessment of the factors mentioned in the conclusions (organizational, ethical and related to the current evidence on treatments).

Authors' methods: A systematic review (SR) of the scientific evidence was performed. Experimental or observational controlled primary studies and economic evaluations, which report the differences between groups in dislocation rates, were included. The following electronic databases were searched from 2012 to February 2016: MEDLINE and PREMEDLINE (OvidSP), EMBASE (Elsevier), PsycINFO (EBSCO Host), CINAHL (EBSCO Host) and Cochrane (Wiley Online Library). For the economic evaluation, the average cost and effectiveness in children undergoing and not subject to the program were compared. A decision tree that summarizes the information extracted from the literature and expert opinion was used. In the model, the perspective of the National Health System (NHS) was adopted and a time horizon of 18 years was considered. The measure of effectiveness was the quality-adjusted life years. Deteminístic and probabilistic sensitivity analysis were performed using Monte Carlo simulations, which allowed us to compute the acceptability cost-effectiveness curves.

Project Status: Completed

Year Published: 2016

URL for published report: https://sescs.es/efectividad-de-los-programas-de-vigilancia-para-prevenir-la-luxacion-de-cadera-en-paralisis-cerebral/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es