Objectives: Decisions about population screening require consideration of whether individual and healthcare system benefits outweigh harms, and whether the opportunity cost of screening is justified by the overall benefits it generates. Developing cost-effectiveness models for screening interventions is complex. This paper outlines the processes, challenges, and required evidence generation to create a decision model of pulse oximetry (PO) screening for well appearing newborns. Methods: We build on an existing approach to model conceptualisation for public health interventions, applying it to screening of PO for hypoxaemia. Our process includes: iterative stakeholder consultation; development of criteria to determine key drivers of test value, and identification of data requirements, potential sources of evidence and research to fill evidence gaps. Results: Our iterative consultation revealed heterogeneity in PO delivery and interpretation. Stakeholders agreed that impacts among newborns without cardiac conditions were drivers of test value. Diagnostic accuracy was available for detection of critical congenital heart disease (cCHD), but evidence on other detectable conditions, changes in time to diagnosis, treatment and health outcomes was lacking. We identified linkage of routine datasets and further analysis that could address evidence gaps. Conclusions: We outline three areas of challenges for model conceptualisation in PO screening: Lack of evidence to characterise the pathway from screening to diagnosis to treatment; generalisability of evidence to how a test is implemented in a health system; and cognitive biases that influence stakeholders. To justify further research to address these challenges, an important consideration is whether the information value would exceed research costs.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)