Cost-effectiveness Analysis of Screening Extremely Low Birth Weight Children for Hepatoblastoma Using Serum
Rebecca MacDonell-Yilmaz1, Kelly Anderson2, Bradley DeNardo1
1Hasbro Children's Hospital/Brown University, Providence, RI.
Insights
Screening extremely low birth weight (ELBW) infants for hepatoblastoma with alpha-fetoprotein tests is cost-effective. This approach improves survival rates and quality-adjusted life-years (QALYs) for affected children.
Area of Science:
- Pediatric Oncology
- Health Economics
- Screening Programs
Background:
- Hepatoblastoma is a rare but serious cancer in infants.
- Children born at extremely low birth weight (ELBW) have an increased risk.
- Current screening protocols for this population are lacking.
Purpose of the Study:
- To evaluate the cost-effectiveness of serial serum alpha-fetoprotein screening for hepatoblastoma in ELBW infants.
- To compare this screening strategy against the current standard of care (no screening).
Main Methods:
- A decision tree model was developed to simulate costs and outcomes.
- The model incorporated discounted lifetime costs and benefits in 2018 US dollars.
- Univariate sensitivity analyses were performed to assess parameter uncertainty.
Main Results:
- Screening is associated with 77.7 additional quality-adjusted life-years (QALYs) annually for an estimated cost of $8.7 million.
- The incremental cost-effectiveness ratio is approximately $112,000/QALY, considered cost-effective from a US societal perspective.
- For diagnosed cases, screening increased survival by 10.1%, QALYs by 4.18%, and decreased costs by $245,184.
Conclusions:
- Screening ELBW children for hepatoblastoma between 3 and 48 months of age is cost-effective.
- The proposed screening strategy dominates the alternative of no screening from a societal viewpoint.
Objectives:
To evaluate the cost-effectiveness of screening children born at extremely low birth weight (ELBW) for hepatoblastoma using serial serum alpha-fetoprotein measurements.
Study Design:
We created a decision tree to evaluate the cost effectiveness of screening children born at ELBW between 3 and 48 months of age compared with current standard of care (no screening). Our model used discounted lifetime costs and monetary benefits in 2018 US dollars, based on estimates in the published literature. The effects of uncertainty in model parameters were also assessed using univariate sensitivity analyses, in which we changed the values for one parameter at a time to assess the effect on the estimated incremental cost-effectiveness ratio.
Results:
For the estimated 55 699 children born at ELBW in the US each year, this screening is associated with 77.7 additional quality-adjusted life-years (QALYs) at a cost of $8.7 million. This results in an incremental cost-effectiveness ratio of about $112 000/QALY, which is considered cost effective from a US societal perspective. For children diagnosed with hepatoblastoma, our model finds that the screening regimen is associated with a 10.1% increase in survival, a 4.18% increase in expected QALYs, and a $245 184 decrease in expected cost.
Conclusions:
Screening ELBW children for hepatoblastoma between 3 and 48 months of age dominates the alternative and is cost effective from a societal perspective.
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