King William E, Carlo Waldemar A, O'Shea T Michael, Schelonka Robert L
Medical Predictive Science Corporation, Charlottesville, VA, United States.
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States.
Front Health Serv. 2022 Sep 7;2:960945. doi: 10.3389/frhs.2022.960945. eCollection 2022.
Over 50,000 very low birth weight (VLBW) infants are born each year in the United States. Despite advances in care, these premature babies are subjected to long stays in a neonatal intensive care unit (NICU), and experience high rates of morbidity and mortality. In a large randomized controlled trial (RCT), heart rate characteristics (HRC) monitoring in addition to standard monitoring decreased all-cause mortality among VLBW infants by 22%. We sought to understand the cost-effectiveness of HRC monitoring to improve survival among VLBW infants.
We performed a secondary analysis of cost-effectiveness of heart rate characteristics (HRC) monitoring to improve survival from birth to NICU discharge, up to 120 days using data and outcomes from an RCT of 3,003 VLBW patients. We estimated each patient's cost from a third-party perspective in 2021 USD using the resource utilization data gathered during the RCT (NCT00307333) during their initial stay in the NICU and applied to specific per diem rates. We computed the incremental cost-effectiveness ratio and used non-parametric boot-strapping to evaluate uncertainty.
The incremental cost-effectiveness ratio of HRC-monitoring was $34,720 per life saved. The 95th percentile of cost to save one additional life through HRC-monitoring was $449,291.
HRC-monitoring appears cost-effective for increasing survival among VLBW infants.
在美国，每年有超过50000名极低出生体重（VLBW）婴儿出生。尽管护理水平有所提高，但这些早产儿仍需在新生儿重症监护病房（NICU）长期住院，且发病率和死亡率很高。在一项大型随机对照试验（RCT）中，除标准监测外，心率特征（HRC）监测使VLBW婴儿的全因死亡率降低了22%。我们试图了解HRC监测对提高VLBW婴儿生存率的成本效益。
我们使用一项针对3003名VLBW患者的RCT（NCT00307333）的数据和结果，对心率特征（HRC）监测从出生到NICU出院（最长120天）提高生存率的成本效益进行了二次分析。我们从第三方角度，使用RCT期间收集的资源利用数据，以2021年美元估算了每位患者在NICU初始住院期间的成本，并应用了特定的每日费用率。我们计算了增量成本效益比，并使用非参数自举法评估不确定性。
HRC监测的增量成本效益比为每挽救一条生命34720美元。通过HRC监测挽救一条额外生命的成本的第95百分位数为449291美元。
HRC监测对于提高VLBW婴儿的生存率似乎具有成本效益。
