{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:47:51Z","timestamp":1787510871443,"version":"build-2736575974"},"reference-count":71,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,6,1]],"date-time":"2020-06-01T00:00:00Z","timestamp":1590969600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the recommended three\u2010view fetal heart screening method to detect major congenital heart disease (CHD) with more elaborate screening strategies to determine the cost\u2010effective strategy in unselected (low\u2010risk) pregnancies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A decision\u2010analytic model was designed to compare four screening strategies to identify fetuses with major CHD in a theoretical cohort of 4 000 000 births in the USA. The four strategies were: (1) three views: four\u2010chamber view (4CV) and views of the left (LVOT) and right (RVOT) ventricular outflow tracts; (2) five views: 4CV, LVOT, RVOT and longitudinal views of the ductal arch and aortic arch; (3) five axial views: 4CV, LVOT, RVOT, three\u2010vessel (3V) view and three\u2010vessels\u2010and\u2010trachea view; and (4) six views: 4CV, LVOT, RVOT and 3V views and longitudinal views of the ductal arch and aortic arch. Outcomes related to neonatal mortality and neurodevelopmental disability were evaluated. The analysis was performed from a healthcare\u2010system perspective, with a cost\u2010effectiveness willingness\u2010to\u2010pay threshold set at $100 000 per quality\u2010adjusted life year (QALY). Baseline analysis, one\u2010way sensitivity analysis and Monte\u2010Carlo simulation were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In our baseline model, screening with five axial views was the optimal strategy, detecting 3520 more CHDs, and resulting in 259 fewer children with neurodevelopmental disability, 40 fewer neonatal deaths and only slightly higher costs, compared with screening with the currently recommended three views. Screening with six views was more effective, but also cost considerably more, compared with screening with five axial views, and had an incremental cost of $490 023\/QALY, which was over the willingness\u2010to\u2010pay threshold. The five\u2010view strategy was dominated by the other three strategies, i.e. it was more costly and less effective in comparison. The data were robust when tested with Monte\u2010Carlo and one\u2010way sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although current guidelines recommend a minimum of three views for detecting CHD during the mid\u2010trimester anatomy scan, screening with five axial views is a cost\u2010effective strategy that may lead to improved outcome compared with three\u2010view screening. Copyright \u00a9 2020 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.21977","type":"journal-article","created":{"date-parts":[[2020,1,16]],"date-time":"2020-01-16T13:26:43Z","timestamp":1579181203000},"page":"758-767","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Detection of fetal cardiac anomalies: cost\u2010effectiveness of increased number of cardiac views"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8866-1812","authenticated-orcid":false,"given":"G. S.","family":"Bak","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynecology Odense University Hospital  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. L.","family":"Shaffer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Division of Maternal\u2010Fetal Medicine, Oregon Health &amp; Science University  Portland OR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Madriago","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Pediatric Cardiology, Oregon Health &amp; Science University  Portland OR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Division of Maternal\u2010Fetal Medicine, Oregon Health &amp; Science University  Portland OR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Pediatric Cardiology, Oregon Health &amp; Science University  Portland OR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. B.","family":"Caughey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Division of Maternal\u2010Fetal Medicine, Oregon Health &amp; Science University  Portland OR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Pereira","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Division of Maternal\u2010Fetal Medicine, Oregon Health &amp; Science University  Portland OR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)01886-7"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2013.32.6.1083"},{"key":"e_1_2_7_4_1","first-page":"348","article-title":"International Society of Ultrasound in Obstetrics and Gynecology","volume":"41","author":"ISUOG Practice Guidelines (updated): sonographic screening examination of the fetal heart","year":"2013","journal-title":"Ultrasound Obstet Gynecol"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/2047487314551547"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13287"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1322"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.3830"},{"key":"e_1_2_7_9_1","unstructured":"The Fetal Medicine Foundation. 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