Cost-effectiveness Analysis of Screening Extremely Low Birthweight Children for Hepatoblastoma Using Serum Alpha-fetoprotein.

OBJECTIVES To evaluate the cost-effectiveness of screening children born at extremely low birth weight (ELBW) for hepatoblastoma using serial serum alpha-fetoprotein (AFP) measurements. STUDY DESIGN We created a decision tree to evaluate the cost-effectiveness of screening children born at ELBW between 3 months and 48 months of age compared with current standard of care (no screening). Our model used discounted lifetime costs and monetary benefits in 2018 U.S. dollars (USD), based on estimates in the published literature. The effects of uncertainty in model parameters were also assessed using univariate sensitivity analyses, in which we changed the values for one parameter at a time to assess the effect on the estimated incremental cost-effectiveness ratio (ICER). RESULTS For the estimated 55,699 children born at ELBW in the United States each year, this screening is associated with 77.7 additional quality-adjusted life-years (QALYs) at a cost of $8.7 million. This results in an ICER of about $112,000/QALY, which is considered cost-effective from a U.S. Societal perspective. For children diagnosed with hepatoblastoma, our model finds that the screening regimen is associated with 10.1% increase in survival, a 4.18 increase in expected QALYs, and a $245,184 decrease in expected cost. CONCLUSIONS Screening ELBW children for hepatoblastoma between 3 months and 48 months of age dominates the alternative and is cost-effective from a societal perspective.