469 - Economic and Patient Care Benefits of Transcutaneous Bilirubin versus Total Serum Bilirubin for the Detection of Neonatal Hyperbilirubinemia

Publication Number: 469.4973

Meera N. Sankar, Stanford University School of Medicine, Palo Alto, CA, United States; Alexander J. Fox, Stanford University School of Medicine, Stanford, CA, United States; Aydin Zahedivash, Stanford University School of Medicine, Palo Alto, CA, United States; Jessica Pullen, Stanford University School of Medicine, Stanford, CA, United States

Background:

Background: Transcutaneous Bilirubin (TcB) has become increasingly utilized as a non-invasive tool for assessing jaundice in newborns. Prior studies have demonstrated strong correlation to Total Serum Bilirubin (TSB) levels in both term and preterm infants. While several studies have focused on the safety and accuracy of TcB levels, the economic and patient care benefits of TcB versus TSB have yet to be fully elucidated.

Objective:

Objective: To conduct a cost benefit analysis of TcB versus TSB for the detection of neonatal hyperbilirubinemia.

Design/Methods:

Design/Methods: This retrospective study utilized TcB and TSB data from term and preterm infants admitted to a single-center level III NICU in Northern California from 11-1-2022 to 9-15-2023. TcB measurements were taken by trained nursing staff using a Draeger Jaundice Meter (JM-105) within 30-60 minutes of a TSB level. TcBs were also obtained independent of lab draws when ordered by a physician. Phototherapy was administered per protocol for TSB levels at threshold. Total instances of TcB and TSBs per patient were used to calculate the costs, with TcB measurements outside of the standard one hour time frame considered an instance of a saved TSB blood draw. Cost variables included single-use equipment for TcB measurements and TSB laboratory draws. Average costs of TcB and TSB were analyzed using a two-tailed t-test and mean preventable blood loss by gestational age was analyzed by ANOVA.

Results:

Results: Among the 284 term and preterm infants in the NICU, an average of 3 TcBs and 5.6 TSBs were measured per patient which corresponded to an average cost of $3.96 [95% CI 3.69, 4.23] and $284.12 [95% CI 267.27, 300.96], p < 0.001. Independent TcB measurements that acted as a proxy for TSB draws resulted in an average of 2 pokes saved per infant, representing 1.33mL of prevented blood loss [95% CI 1.24, 1.43]. This translated to a cost saving of $109.44 per baby for a total of $31,079.97. A greater prevented blood loss volume corresponded with lower gestational ages with infants saving a mean of 1.05mL [95% CI 0.98, 1.11] at 37-41wks, 1.58mL [95% CI 1.48, 1.67] at 34-37wks, 1.52mL [95% CI 1.41, 1.63] at 30-34wks and 2.14mL [95% CI 2.00, 2.27,] at < 30 wks (p < 0.001 for all). (Figure 1)

Conclusion(s):

Conclusions: Our cost-benefit analysis showed that the use of TcB for detecting hyperbilirubinemia has significant benefits for decreasing painful procedures and blood loss in the NICU setting while also resulting in substantial cost savings which could be particularly impactful in lower resource and community hospital settings.

Preventable blood loss by gestational age
Figure 1: Preventable blood loss in milliliters stratified by gestational age.