Cost-effectiveness of strategies that are intended to prevent kernicterus in newborn infants.

摘要: Objective. There is concern about an increasing incidence of kernicterus in healthy term neonates the United States. Although unknown, several potential strategies that are intended to prevent have been proposed by experts. It necessary assess costs, benefits, and risks such before widespread policy changes made. The objective this study was determine direct costs a case with following 3 strategies: (1) universal follow-up office or at home within 1 2 days early newborn discharge, (2) routine predischarge serum bilirubin selective laboratory testing, (3) transcutaneous testing. Methods. We performed incremental cost-effectiveness analysis compared current practice. used decision analytic model spreadsheet estimate outcomes, including savings resulting from prevented kernicterus, for annual cohort 800 000 newborns who eligible discharge. modified societal perspective 2002 US dollars. With each strategy, test treatment thresholds hyperbilirubinemia lowered Results. base-case assumptions (current 1:100 relative risk reduction [RRR] 0.7 strategy), cost $10 321 463, $5 743 905, $9 191 352 respectively 1, 2, listed above. total were, respectively, $202 300 671, $112 580 535, $180 150 494. Sensitivity analyses showed per highly dependent on population RRR both which currently unknown. In our model, $46 179 465 would result strategy if high (1:10 births higher) (≥0.7). If lower lower, then ranged $4 145 676 as $77 650 240. Conclusions. Widespread implementation these likely increase health care significantly uncertain benefits. premature implement screening large scale. However, may benefits beyond prevention, we did not include model. Research required epidemiology, factors, causes kernicterus; evaluate effectiveness quality-adjusted life year any preventive strategy.