Faculty Collaboration Database

Three cost-utility analyses of screening for intracranial hemorrhage in neonates with hemophilia. J Pediatr Hematol Oncol 2014 Aug;36(6):474-9

Date

07/24/2014

Pubmed ID

25054457

DOI

10.1097/MPH.0000000000000174

Scopus ID

2-s2.0-84905015377 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

BACKGROUND: Intracranial hemorrhage (ICH) in the newborn period is a potential cause of serious morbidity and mortality in individuals with hemophilia. The incidence of ICH is estimated to be 2% to 4%; however, depending on the mode of delivery, it may be considerably higher. Considering the varying sensitivities and costs of various imaging modalities, there remains controversy surrounding universal cranial imaging. Cost-utility analysis is the ideal tool to display the consequences of a decision made.

METHODS: We constructed a decision tree to evaluate the direct and indirect costs, possible outcomes, and probabilities of ICH in neonates with hemophilia. We created 3 decision analysis models to evaluate the cost-utility of different screening modalities for ICH: ultrasound, computed tomography, and magnetic resonance imaging. Within each model, 3 different strategies were compared: screen all neonates; screen only neonates born by instrumented delivery; and not screen any neonates. A societal perspective was used for all models. The base case models were later reanalyzed in sensitivity analysis to account for uncertainties.

RESULTS: Total costs for screening all neonates, screening only neonates born by instrumented delivery, and not screening any neonates were $9501, $9297, and $9347, respectively, for US, and $9761, $9351, and $9353, respectively, for CT. Screening instrumented deliveries using MRI had an incremental cost-effectiveness ratio of $12,440.

CONCLUSIONS: Screening newborns born by an instrumented delivery appears to be the most cost-effective strategy irrespective of the imaging modality. Subsequent studies will require a longer time frame to factor in possible late effects of radiation, anesthesia, and the high cost of factor replacement and hospital admission.

Author List

Malec LM, Sidonio RF Jr, Smith KJ, Cooper JD

Author

Lynn M. Malec MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cost-Benefit Analysis
Decision Support Techniques
Decision Trees
Health Expenditures
Hemophilia A
Humans
Infant, Newborn
Intracranial Hemorrhages
Magnetic Resonance Imaging
Neonatal Screening
Prevalence
Quality of Life
Sensitivity and Specificity
Tomography, X-Ray Computed
Ultrasonography
Uncertainty