Overview

This report summarizes a discrete-event simulation cost-effectiveness analysis for one India NICU with 3,300 admissions per year and 8 available bCPAP devices. The model compares No bCPAP to bCPAP over a 10-year time horizon using 1,000 simulation runs.

Metric Value
Admissions per year 3,300
Simulation horizon (years) 10
Number of simulation runs 1,000
bCPAP devices in NICU 8
Average annual RDS cases 161.59
Average annual RDS deaths averted 17.72
Average annual discounted DALYs averted 388.70
Mean annual bCPAP program add-on cost per treated patient (USD) 58.76
Mean annual total bCPAP cost per RDS patient (USD) 158.60
Mean no bCPAP cost per RDS patient (USD) 100.00
Mean incremental cost per NICU admission (USD) 2.866
Average annual discounted incremental cost (USD) 8,310.32
ICER (USD per discounted DALY averted) 21.38

CEA Results

The table below follows the format you provided. In this report, the comparator is No bCPAP rather than Nasal Cannula, because the current model only includes those two strategies. The discounted DALY column is interpreted as discounted DALYs averted relative to the No bCPAP comparator.

Intervention discounted cost discounted DALY ICER
No bCPAP 141,975.29 0.00 na
bCPAP 225,078.48 3,887.00 21.38

The bCPAP strategy increases average discounted 10-year cost per NICU run from 141,975.29 USD to 225,078.48 USD and generates 3,887.00 discounted DALYs averted, giving an ICER of 21.38 USD per discounted DALY averted.

To compare arm-level patient costs on a like-for-like basis, the table below divides each arm’s discounted 10-year total cost by the mean number of RDS patients in that arm over the same 10-year period.

Intervention Mean discounted 10-year total cost (USD) Mean 10-year RDS patients Discounted cost per RDS patient (USD)
No bCPAP 141,975.29 1,615.93 87.86
bCPAP 225,078.48 1,615.93 139.29

Model Parameters

Parameter Value
Probability of term birth 0.60
Relative split of preterm births Late preterm 85.4%, very preterm 10.4%, extremely preterm 4.2% of all preterm births
RDS probability in term births 0.00333
RDS probability in late preterm births 0.050
RDS probability in very preterm births 0.333
RDS probability in extremely preterm births 0.95
RDS case fatality without bCPAP 0.235
RDS case fatality with bCPAP 0.125
India life expectancy at birth (years) 72
DALY multiplier applied to life expectancy 0.85
Annual discount rate 0.03
Supplies cost per treated patient (USD) 3.21
NICU cost per day (USD) 25.00
Oxygen cost per liter (USD) 0.0003
Oxygen liters per treated patient-day 25,000
Oxygen cost per treated patient-day (USD) 7.50
Nursing labor minutes per treated patient-day 15
Nurse annual salary (USD) 3,000.00
Nurse work hours per year 2,000
Nurse hourly cost (USD) 1.50
Nursing labor cost per treated patient-day (USD) 0.375
Device capital cost (USD) 500.00
Device useful life (years) 3
Annualized device cost per device-year (USD) 166.67

Calculation Method

  1. The DES simulates one NICU with 3,300 annual admissions over 10 years.
  2. Each admission is assigned to a gestational-age category using the specified term and preterm probabilities.
  3. RDS status is assigned using gestational-age-specific RDS probabilities.
  4. RDS patients occupy NICU beds for a simulated length of stay, and bCPAP devices are allocated subject to the available device capacity in the model.
  5. Treated RDS cases use the bCPAP case fatality rate and untreated RDS cases use the no-bCPAP case fatality rate.
  6. Deaths averted are converted to DALYs using 0.85 * life expectancy at birth, and those DALYs are discounted at 3% per year.
  7. Costs include supplies per treated patient, oxygen per treated patient-day, nursing labor per treated patient-day, NICU cost per day, and annualized device capital cost.

Annual Simulation Results

Metric Mean SD
Average annual RDS cases 161.59 12.76
Average annual RDS cases treated with bCPAP 161.13 12.55
Average annual RDS cases untreated 0.47 0.91
Average annual deaths averted 17.72 1.38
Average annual discounted DALYs averted 388.70 44.89
Average annual device utilization 0.331 0.027
Average annual oxygen cost (USD) 7,246.03 584.19
Average annual nursing labor cost (USD) 362.30 29.21
Mean annual bCPAP program add-on cost per treated patient (USD) 58.76 1.36
Mean annual total bCPAP cost per RDS patient (USD) 158.60 4.66
Mean no bCPAP cost per RDS patient (USD) 100.00 3.50
Mean incremental cost per NICU admission (USD) 2.866 0.193
Average annual incremental cost (USD) 9,458.89 651.91
Average annual discounted incremental cost (USD) 8,310.32 905.79

mean_bcpap_program_cost_per_treated_patient_usd is the average bCPAP-specific add-on program cost per treated RDS patient, including supplies, oxygen, nursing labor, and annualized device capital but excluding NICU bed-day cost. mean_bcpap_total_cost_per_rds_patient_usd is the average total annual cost per RDS patient in the bCPAP arm, including NICU bed-day cost. mean_no_bcpap_cost_per_rds_patient_usd is the average total annual cost per RDS patient in the no-bCPAP arm. mean_incremental_cost_per_nicu_admission_usd is the incremental cost spread across all NICU admissions.

average_annual_device_utilization is the fraction of available device-days used in a typical year. With 8 devices, a utilization of 0.331 means that roughly 2.65 devices are in use on an average day.