Cost Analysis of Cot-Side Screening Methods for Neonatal Hypoglycaemia.
Cost Analysis of Cot-Side Screening Methods for Neonatal Hypoglycaemia.
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DOI：
10.1159/000489080
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发表时间：
2018
期刊：
影响因子：
2.5
通讯作者：
for the CHYLD Study Team
中科院分区：
文献类型：
--
作者：
Glasgow MJ;Harding JE;Edlin R;for the CHYLD Study Team
有新生儿低血糖风险的婴儿通常使用床旁血糖仪进行筛查，但非酶促血糖仪不准确，可能导致过度治疗和治疗不足，并且低值需要实验室确认。更精确的酶促血糖仪是可用的，但成本显然更高。我们的目的是比较使用床旁酶和非酶血糖仪筛查新生儿低血糖的成本。我们使用决策树来建模成本，包括消耗品和员工时间。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结果的概率、非酶促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，使用酶促血糖仪进行筛查的成本为86.94新西兰元（63.47美元），而使用非酶促血糖仪的成本为97.08新西兰元（70.87美元）。敏感性分析表明，使用酶促血糖仪可以节省成本，员工时间和成本差异很大，不考虑非酶促血糖仪的假阳性水平，并且≥ 78%的低值经实验室确认。非酶血糖仪的成本可能较低（例如，假阴性率超过15%），则将遗漏低血糖事件。将血糖浓度阈值降低至1.94 mmol/L，低血糖的发生率从52%降低至13%，使用非酶促血糖仪进行筛查的成本降至47.71新西兰元（34.83美元）。鉴于酶促血糖仪在大多数情况下成本较低且准确性较高，应常规用于新生儿低血糖的床旁筛查。
Babies at risk of neonatal hypoglycaemia are often screened using cot-side glucometers, but non-enzymatic glucometers are inaccurate, potentially resulting in over- 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 NZ$86.94 (US$63.47) while using a non-enzymatic glucometer cost NZ$97.08 (US$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 NZ$47.71 (US$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.