Biliary atresia universal screening cost-effective only at certain willingness-to-pay thresholds
11 Oct 2022
“As they grow a single patient, they don’t want to generate USD1,000 a year... It’s better to generate USD2,000 a year off each patient,” remarks Crème.Of various universal screening modalities for biliary atresia, the stool colour card and direct bilirubin (DB) measurements prove to be cost-effective depending on willingness-to-pay thresholds (WTP), a new Japan has found.
“Coupling the screening efforts for biliary atresia with other diseases in early infancy that also manifest symptoms through the stool can be considered to improve cost-effectiveness,” the researchers said.
The study employed a decision analytic Markov microsimulation model to assess screening through a stool colour card or DB testing, as compared with no screening. The outcome of interest for all newborns was event-free life-years, defined as liver transplant (LT)-free survival. Screening methods were also evaluated according to costs and incremental cost-effectiveness ratio (ICER) over 25 years.
A total of 941,000 infants were included in the analytic model, of whom 114 had biliary atresia. In the base-case analysis, the stool colour card screening method cost US $14,927,337 more than no screening, yielding 44 more event-free life years. The resulting ICER was US $339,258 per event-free life-year gained.
Meanwhile, DB screening imposed US $138,994,060 more than the stool colour card, yielding 271 more event-free life-years gained, at an ICER of US $512,893 per gain. Compared with no screening, DB had an ICER of US $488,639 per event-free life-year gained.
In terms of LT, DB screening resulted in 16 fewer transplantations than stool colour card screening. Meanwhile, stool colour assessments decreased LTs by two as opposed to no screening.