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Cost-effectiveness analysis of a system-based approach for managing neonatal jaundice and preventing kernicterus in
Bin Xie1, Orlando da Silva, Greg Zaric
1University of Western Ontario, London, Ontario.
Insights
A system-based approach for managing neonatal jaundice is cost-effective, preventing kernicterus (a type of brain damage) for $570,496 per case. This method offers a lower cost per life year gained compared to traditional practices.
Area of Science:
- Neonatal care
- Public health
- Health economics
Background:
- Neonatal jaundice is common, and kernicterus is a preventable form of brain damage.
- Traditional management relies on visual inspection and selective bilirubin testing, which may miss at-risk infants.
- A system-based approach offers a structured method for identifying and managing hyperbilirubinemia.
Purpose of the Study:
- To evaluate the incremental cost-effectiveness of a system-based approach for neonatal jaundice management.
- To compare this approach against traditional practices in term and late-preterm infants.
- To assess the prevention of kernicterus and its associated costs.
Main Methods:
- A hypothetical cohort analysis of 150,000 neonates was conducted.
- Costs and outcomes were compared between a system-based approach and traditional practice.
- Data were sourced from a teaching hospital in Ontario and existing literature.
Main Results:
- The system-based approach had a slightly higher per-child cost ($176 vs. $173).
- Increased costs for screening, treatment, and follow-up were offset by reduced emergency visits and readmissions.
- The cost to prevent one kernicterus case was $570,496, with a cost per quality-adjusted life year of $65,698.
Conclusions:
- The system-based approach is a cost-effective strategy for preventing kernicterus.
- The cost per kernicterus case prevented is lower than previously reported.
- This approach represents an efficient use of resources in neonatal care.
Objective:
To evaluate the incremental cost-effectiveness of a system-based approach for the management of neonatal jaundice and the prevention of kernicterus in term and late-preterm (≥35 weeks) infants, compared with the traditional practice based on visual inspection and selected bilirubin testing.
Study Design:
Two hypothetical cohorts of 150,000 term and late-preterm neonates were used to compare the costs and outcomes associated with the use of a system-based or traditional practice approach. Data for the evaluation were obtained from the case costing centre at a large teaching hospital in Ontario, supplemented by data from the literature.
Results:
The per child cost for the system-based approach cohort was $176, compared with $173 in the traditional practice cohort. The higher cost associated with the system-based cohort reflects increased costs for predischarge screening and treatment and increased postdischarge follow-up visits. These costs are partially offset by reduced costs from fewer emergency room visits, hospital readmissions and kernicterus cases. Compared with the traditional approach, the cost to prevent one kernicterus case using the system-based approach was $570,496, the cost per life year gained was $26,279, and the cost per quality-adjusted life year gained was $65,698.
Conclusion:
The cost to prevent one kernicterus case using the system-based approach is much lower than previously reported in the literature.
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