title: Cost-effective analysis of screening for biliary atresia with the stool color card.
abstract: BACKGROUND
  Biliary atresia (BA) is the leading cause of pediatric end-stage liver disease and liver transplantation in the United States. Early diagnosis leads to improved outcomes, but diagnosis is often delayed, leading to increased rates of transplantation and mortality.
  
  
  METHODS
  A Markov model was developed to simulate the natural history and transplant-related outcomes of patients with BA in a US cohort studied for 20 years. Data regarding proportions of individuals in different health states, including transplant and death, were obtained from published literature. Costs were derived from the literature and the Johns Hopkins database of charges using the cost-to-charge ratio. Strategy A represented the status quo and assumed no screening. Strategy B used nationwide screening with the stool color card developed by the Taiwan Health Bureau. The cost associated with both strategies was compared with the number of life-years gained, deaths, and the number of transplants for a 20-year interval. A dominant strategy was one that was associated with lower cost alongside improved outcomes, including increases in life-years gained, reductions in number of deaths, and reductions in number of transplants. One-way and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  In strategy A, the 20-year cost was $142,479,725 with 3702 life-years, 74 deaths and 158 liver transplants. For strategy B, the cost was $133,893,563 with 3731.7 life-years, 71 deaths and 147 liver transplants. There was a >97% probability that screening with the stool color card would be cost saving and associated with an increase in life-years gained. Among all parameters, only stool color card specificity was associated with the potential for screening to no longer be cost saving.
  
  
  CONCLUSIONS
  Compared with no screening, screening with the stool color card is a dominant strategy associated with lower costs and better outcomes. These findings suggest that screening with the stool color card could be an important, economically feasible strategy for improving outcomes in BA in the United States.
authors.affiliation: *Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins University School of Medicine †Department of Health Policy and Management, Johns Hopkins University School of Public Health ‡Department of Financial Analysis, Johns Hopkins Hospital §Johns Hopkins Carey Business School, Baltimore, MD.
authors.forename: Douglas
authors.initials: D
authors.lastname: Mogul
authors.forename: Mo
authors.initials: M
authors.lastname: Zhou
authors.forename: Paul
authors.initials: P
authors.lastname: Intihar
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schwarz
authors.forename: Kevin
authors.initials: K
authors.lastname: Frick
mesh_terms: D001656:Biliary Atresia / Q000175:diagnosis* / Q000191:economics / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D003116:Color; D042241:Early Diagnosis; D005189:False Positive Reactions; D005240:Feasibility Studies; D005243:Feces / Q000737:chemistry*; D017048:Health Care Costs; D006801:Humans; D007231:Infant, Newborn; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics; D008390:Markov Chains; D015997:Neonatal Screening / Q000191:economics / Q000379:methods*; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D014481:United States