Home-based screening for biliary atresia using infant stool colour cards: a large-scale prospective cohort study and...

Area of Science:

• Pediatric Gastroenterology
• Public Health Screening Programs
• Health Economics

Background:

• Biliary atresia (BA) is a primary cause of pediatric liver failure and transplantation, often diagnosed late, leading to poor outcomes.
• Delayed diagnosis of BA worldwide remains a significant clinical challenge.
• Infant stool colour card (ISCC) screening offers a potential solution for early detection.

Purpose of the Study:

• To evaluate the cost-effectiveness of implementing an ISCC screening program for BA in Canada.
• To assess different methods for introducing the ISCC screening program.

Main Methods:

• A prospective study involving 6,187 newborns at BC Women's Hospital, utilizing six screening strategies from passive distribution to physician reminders.
• ISCC utilization rate was the primary outcome, combining return and non-return card usage.
• Markov modeling predicted incremental costs and life years gained over 10 years compared to no screening.

Main Results:

• Card utilization rates in the passive strategy ranged from 60-94%.
• For a Canadian population, passive screening incurred an additional cost of $213,584, gaining 9.7 life years ($22,000 per life-year gained).

Conclusions:

• A BA ISCC screening program is feasible for Canadian newborns.
• Passive ISCC distribution at maternity is a potentially effective and highly cost-effective strategy for early BA detection.