Glasgow Matthew J, Harding Jane E, Edlin Richard
Liggins Institute, University of Auckland, Auckland, New Zealand.
School of Population Health, University of Auckland, Auckland, New Zealand.
Neonatology. 2018;114(2):155-162. doi: 10.1159/000489080. Epub 2018 Jun 12.
Babies at risk of neonatal hypoglycaemia are often screened using cot-side glucometers, but non-enzymatic glucometers are inaccurate, potentially resulting in over-treatment and under-treatment, and low values require laboratory confirmation. More accurate enzymatic glucometers are available but at apparently higher costs.
Our objective was to compare the cost of screening for neonatal hypoglycaemia using point-of-care enzymatic and non-enzymatic glucometers.
We used a decision tree to model costs, including consumables and staff time. Sensitivity analyses assessed the impact of staff time, staff costs, probability that low results are confirmed via laboratory testing, false-positive and false-negative rates of non-enzymatic glucometers, and the blood glucose concentration threshold.
In the primary analysis, screening using an enzymatic glucometer cost NZD 86.94 (USD 63.47) while using a non-enzymatic glucometer cost NZD 97.08 (USD 70.87) per baby. Sensitivity analyses showed that using an enzymatic glucometer is cost saving with wide variations in staff time and costs, irrespective of the false-positive level of non-enzymatic glucometers, and where ≥78% of low values are laboratory confirmed. Where non-enzymatic glucometers may be less costly (e.g., false-negative rate exceeds 15%), instances of hypoglycaemia will be missed. Reducing the blood glucose concentration threshold to 1.94 mmol/L reduced the incidence of hypoglycaemia from 52 to 13%, and the cost of screening using a non-enzymatic glucometer to NZD 47.71 (USD 34.83).
In view of their lower cost in most circumstances and greater accuracy, enzymatic glucometers should be routinely utilised for point-of-care screening for neonatal hypoglycaemia.
有新生儿低血糖风险的婴儿通常使用床边血糖仪进行筛查，但非酶血糖仪不准确，可能导致过度治疗和治疗不足，且低值结果需要实验室确认。有更准确的酶血糖仪，但成本明显更高。
我们的目的是比较使用即时检验酶血糖仪和非酶血糖仪筛查新生儿低血糖的成本。
我们使用决策树对成本进行建模，包括耗材和工作人员时间。敏感性分析评估了工作人员时间、工作人员成本、通过实验室检测确认低值结果的概率、非酶血糖仪的假阳性和假阴性率以及血糖浓度阈值的影响。
在初步分析中，使用酶血糖仪筛查每个婴儿的成本为86.94新西兰元（63.47美元），而使用非酶血糖仪的成本为97.08新西兰元（70.87美元）。敏感性分析表明，无论非酶血糖仪的假阳性水平如何，以及≥78%的低值结果通过实验室确认，使用酶血糖仪在工作人员时间和成本差异很大的情况下都能节省成本。在非酶血糖仪成本可能较低的情况下（例如，假阴性率超过15%），低血糖病例将被漏诊。将血糖浓度阈值降至1.94 mmol/L可将低血糖发生率从52%降至13%，并将使用非酶血糖仪的筛查成本降至47.71新西兰元（34.83美元）。
鉴于酶血糖仪在大多数情况下成本较低且准确性更高，应常规用于新生儿低血糖的即时检验筛查。
