Page 189 - 16Neonatal Jaundice_compressed

Neonatal jaundice

C.6 Results

The marginal cost per test (excluding equipment) was estimated to be £18.56 for TSB and £5.87
for TCB for a test requiring no consumables and £11.37 for a test requiring calibration tips. Using
*
these figures the cost per strategy was calculated as follows for the model’s default input values:

Calculation of total costs per annum of each strategy
1. Current practice
Population: 690 000
Tested with TSB: 690 000 × 0.1 × 0.6 = 41 400
TSB tests: 41 400 × 1.33 = 55 062
Cost: 55 062 × £18.56 = £1.02 million
2. Strategy 2 (TSB to all visually jaundiced babies)
Population: 690 000
Visibly jaundiced: 690 000 × 0.6 = 414 000
TSB tests: 414 000 × 1.33 = 550 620
Cost: 550 620 x £18.56 = £10.22 million
3. Strategy 3 (TCB to all visually jaundiced babies followed by TSB if TCB is positive)
Population: 690 000
Visibly jaundiced: 690 000 × 0.6 = 414 000
TCB tests: 414 000 × 1.33 = 550 620
TSB tests: 550 620 × 0.25 = 137 655
Cost (BiliChek): 550 620 × £11.37 = £6.26 million plus annual equivalent equipment cost
Cost (Minolta): 550 620 × £5.87 = £3.23 million plus annual equivalent equipment cost

Figure C.1 shows how the incremental costs of the TCB strategy (for two different types of meter)
relative to the TSB strategy vary according to the number of meters that would be necessary to
deliver a strategy of TCB testing. The point where the lines plotting the incremental costs of TCB
cross the horizontal axis gives the threshold number of meters for cost neutrality between TCB
and TSB. If the TCB strategy can be delivered with fewer meters than implied by this threshold
then it would be cheaper than the TSB strategy. With the other model values held constant at
their default values, Figure C.1 suggests that a TCB strategy using the cheaper meter will cost less
than the TSB strategy providing that it can be delivered with fewer than 9200 meters.
Figure C.2 strongly suggests that both the TSB and TCB strategies are more expensive than current
practice in terms of test costs. This would be the case even if a much fewer than 9200 TCB meters
were required. The cost-effectiveness of this additional testing ultimately depends on any offsetting
savings and health gains derived as a result of improved outcomes, that is averted kernicterus
cases. This is an unknown but the ‘what-if’ analysis presented in Figure C.3 shows the minimum
number of kernicterus cases that would need to be averted for cost-effectiveness using the model’s
default input values and varying the number of TCB meters.

Figure C.2 shows the test costs of all three strategies in a scenario where 9200 meters are needed
to deliver the TCB strategy.
Figure C.3 shows the total additional cost to the NHS of more intensive testing between a
minimum of 1000 TCB meters and a maximum of 9200. The cost on the x-axis is the
incremental cost difference between ‘current practice’ and more intensive testing. In this figure,
the comparator with current practice is always TCB. If 9200 meters or fewer are purchased, the
cheaper option is always TCB. If more meters are required, then the TSB strategy should be
preferred on cost-effectiveness grounds. The figure shows that the total cost of using 9200
meters would require an additional £9.14 million per year. The number of kernicterus cases to
be averted would have to be at least 1.52 per year for this additional cost of testing to be cost-
effective compared with current practice. Buying only an additional 1000 meters, the total
additional cost would be £2.96 million per year and 0.49 cases of kernicterus would need to be
averted per year for TCB to be more cost-effective than current practice.

* The marginal cost of TCB reflects that 25% of tests will be followed by TSB.

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