Cost-effectiveness and risk associated with infants' hip radiological screening in Italy

Despite the obvious limits in this study and the scarce information regarding the incidence and distribution of CDH in Italy, we believe that the considerations that led us to restrict the use of radiology in the early diagnosis of this disease are valid. A mass radiologic screening program for the detection of CDH in Italy, even in high incidence zones, does not appear appropriate despite the favorable cost/effectiveness ratio reported for Italy and elsewhere for the x-ray exam of the hip. In the opinion of the authors this low cost is in any case superfluous in view of the excellent results achieved with a clinical screening program like the one we propose. In our opinion, therefore, in Italy instead of mass radiological screening programmes, it would be more appropriate to regulate clinical diagnostic examination of the 1st level (obstetrician, pediatrician) as well as the 2nd (pediatric orthopedist) and the radiological service from both a qualitative and quantitative point of view over the entire national territory. This program for improving medical services, expensive and not easily organized, should be ushered in gradually, involving first the areas of highest disease incidence. The objection may be raised that diagnostic accuracy is sufficiently high in these areas, but nonetheless, we believe that these rates are achieved by resorting to radiological examinations, which can be reduced in number