Page 197 - 16Neonatal Jaundice_compressed

Neonatal jaundice

D.3 Model parameters

The treatment cost of IVIG was estimated using the unit costs in Table D.1.

Table D.1 Unit costs for IVIG

Resource Unit cost Source Notes
IVIG £1,000 GDG estimate
Specialty doctor per hour £54 PSSRU (2008) 239 15 minutes set-up time
(www.pssru.ac.uk/pdf/uc/uc2
008/uc2008.pdf)
Nurse, day ward, per hour of £43 PSSRU (2008) 239 4 hours of nurse time
patient contact
Non-elective inpatient bed day £430 NHS Reference Costs Inpatient cost estimated as an
2007/08 242 (currency code excess bed day for non-elective
PB01Z) patient with a major neonatal
diagnosis

It takes 4 hours to administer IVIG and it was assumed that the drip was set up by a specialist
registrar but that a nurse would supervise the treatment for the 4 hours. The treatment is
provided as an inpatient procedure and therefore treatment also includes the resources involved
in the occupation of a hospital bed. This was estimated by using the 2007/08 NHS Reference
Costs 242 excess bed-day cost for a non-elective inpatient with a major neonatal diagnosis.

The cost of an exchange transfusion was estimated using the 2007/08 NHS Reference Costs and
the category of non-elective inpatient with a major neonatal diagnosis. The costs of treatment
are summarised in Table D.2.

Table D.2 Treatment costs
Resource Unit cost Source Notes
Exchange transfusion £2,108 NHS Reference Costs Non-elective inpatient, with a major
2007/08 242 (currency code neonatal diagnosis
PB01Z)
IVIG £1,616 Based on the unit costs in Table D.1

The efficacy of treatment relates to the number needed to treat (NNT) with IVIG to avoid an
exchange transfusion. This in turn influences the number of babies who avoid an exchange
transfusion and its associated mortality. The clinical parameters used in the model are given in
Table D.3.

Table D.3 Clinical parameters
Parameter Value Range (sensitivity analysis) Source
NNT Rhesus disease 2 2 to 3 See Chapter 7
NNT ABO Disease 5 5 to 13 See Chapter 7
Exchange transfusion mortality 2% 0.3% to 2% Jackson (1997) 204 ; Ip et al. (2004) 243

Finally, there is a range of cost–benefit inputs which reflect NICE methodology. These inputs are
shown in Table D.4. The QALY gain of an averted exchange transfusion death is an
approximation of the discounted QALY gain from a life lived in perfect health and for an
average life expectancy.

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