Page 187 - 16Neonatal Jaundice_compressed

Neonatal jaundice

The base-case estimate of the lifetime cost of kernicterus is based on a legal settlement and, as
such, may include costs over and above those which are deemed relevant for the perspective
used by NICE in economic evaluation. A US study 234 used mean lifetime direct and indirect
costs of cerebral palsy as a proxy for kernicterus costs and as a result used a cost of $921,000 (at
2003 prices). However, this method may underestimate the costs as kernicterus is associated
with severe cerebral palsy. Also, untreated hyperbilirubinaemia can also cause hearing loss
without cerebral palsy with a need for cochlear implants and the potential cost savings from
averting these complications are not explicitly considered within the model. The base-case
QALY loss of a kernicterus case can be considered as an upper bound estimate as it is based on
assuming a health state that is as bad as death.

Table C.1 Population characteristics
Item Value Source Notes
Births 690 000 Office for Based on 2007 births
National
Statistics
(2008) 238
Babies identified as 60% GDG
jaundiced on visual
examination
Babies currently tested 10% GDG Testing is assumed to be with TSB
for jaundice on basis
of visual examination
Mean number of tests 1.33 Kuzniewicz et Pre-universal screening this US study estimated 0.8 tests
11
per baby tested a al. (2008) per baby. We assumed that this was based on 60% of
babies being tested, on the basis of the GDG’s estimate
of babies identified as visually jaundiced in the UK. A
weighted average was then used to estimate the tests
per baby in the 60% tested that would give an average
of 0.8 tests per baby overall. In addition, the GDG
considered this a reasonable estimate.
a A TCB positive followed by a TSB is considered as a single test for the purposes of this analysis.

Table C.2 Cost–benefit parameters
Item Value Sensitivity analysis Source
range
Kernicterus case £5.5 million £0–10 million JMW Clinical www.jmw.co.uk/kernicter
Negligence Solicitors us_bilirubinaemia
Discount rate 3.5% NICE guidelines manual Both costs and QALYs are
(2009) 237 discounted
QALY gained per 25 0–25 Calculation This is an approximation,
kernicterus case based on an assumption
avoided that the quality of life
with kernicterus is not
much better than death
Willingness to £20,000 NICE guidelines manual An advisory threshold
pay for a QALY (2009) 237

The resource ‘ingredients’ and their unit costs for TSB and TCB are shown in Table C.3 and
Table C.4, respectively. The resource items include any of the additional staff time required to
undertake a test as part of a routine postnatal visit. It also includes equipment costs and
consumables, those resources that are used up in the provision of the test that cannot be reused.

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