Evidence-based prevention requires evidence-based performance. The case of screening for congenital heart disease in child health care

To illustrate to what extent the cost-effectiveness of an evidence-based prevention programme may depend on evidence-based performance, by the example of screening for congenital heart disease in Dutch child health care. A patient follow-up study on 290 children with congenital heart disease, of which 83 with significant disorders, diagnosed over two years, and born in the south west of the Netherlands. Adequate screening for congenital heart disease at Dutch child health centres, compared to inadequate screening, proves to be effective (OR: 0.18; 95% CI: 0.04-0.87). However only 15% of all patients with significant disorders in this study was adequately screened. Total health care costs involved over two years amount to over $3 million. Of these costs, 13% are to be attributed to screening tests; 8% to referrals resulting from screening. The costs for screening and referrals, as they were actually performed, are estimated at about $72.000 per patient benefiting from it. Were all children to be screened adequately this sum would be reduced to about $15.000. Not only should prevention programmes be evidence-based, but also outcome and quality, monitored by periodically establishing whether they are optimally performed.