Cost-Utility Analysis of Prophylactic Dextrose Gel vs. Standard Care for Neonatal Hypoglycemia In At-Risk Infants.

OBJECTIVE: To evaluate the long-term costs and impact on quality of life of using prophylactic dextrose gel in subjects at increased risk of developing neonatal hypoglycemia.

STUDY DESIGN: A cost-utility analysis was performed from the perspective of the health system, using a decision tree to model the long-term clinical outcomes of neonatal hypoglycemia, including cerebral palsy, epilepsy, vision disturbances, and learning disabilities, in subjects at increased risk of neonatal hypoglycemia who received prophylactic dextrose gel vs standard care. Model parameters including likelihoods of hypoglycemia and admission to a neonatal intensive care unit, were based on the pre-hPOD Study. Estimations of the likelihood of long-term condition(s), and their costs, were based on review of published literature.

RESULTS: Subjects who received prophylactic dextrose gel incurred costs to the health system of around United States $14,000 over an 18 year time horizon, accruing 11.25 quality adjusted life years (QALYs), whereas those who did not receive prophylactic treatment incurred cost of around $16,000 and experienced a utility of 11.10 QALYs.

CONCLUSION: A prophylactic strategy of using dextrose gel in infants at increased risk of neonatal hypoglycemia is likely to be cost effective compared with standard care, to reduce the direct costs to the health system over an 18 year time horizon, and improve quality of life.