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 273.94
Average daily NICU census 45.19
Average daily RDS cases present 3.75
Average annual RDS deaths without bCPAP 64.38
Average annual RDS deaths with bCPAP 35.35
Average annual RDS deaths averted 29.03
Average annual discounted DALYs averted 631.90
Average annual no bCPAP oxygen cost (USD) 947.05
Mean annual bCPAP program add-on cost per treated patient (USD) 20.88
Mean annual total bCPAP cost per RDS patient (USD) 120.16
Mean no bCPAP cost per RDS patient (USD) 103.49
Mean incremental cost per RDS patient (USD) 16.67
Mean incremental cost per NICU admission (USD) 1.382
Average annual discounted incremental cost (USD) 4,006.11
ICER (USD per discounted DALY averted) 6.34

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 249,095.68 0.00 na
bCPAP 289,156.75 6,318.98 6.34

The bCPAP strategy increases average discounted 10-year cost per NICU run from 249,095.68 USD to 289,156.75 USD and generates 6,318.98 discounted DALYs averted, giving an ICER of 6.34 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 249,095.68 2,739.40 90.93
bCPAP 289,156.75 2,739.40 105.55

Model Parameters

Parameter Value
Probability of term birth 0.30
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
Term life expectancy conditional on surviving to month 1 (years) 73.151
Late preterm life expectancy conditional on surviving to month 1 (years) 70.802
Very preterm life expectancy conditional on surviving to month 1 (years) 70.148
Extremely preterm life expectancy conditional on surviving to month 1 (years) 69.507
DALY multiplier applied to conditional 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 5,760
Oxygen cost per treated patient-day (USD) 1.73
Probability of nasal cannula in no bCPAP arm 1.00
Nasal cannula oxygen liters per patient-day 2,880
Nasal cannula oxygen cost per patient-day (USD) 0.86
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 gestational-age-specific life expectancy conditional on surviving to month 1 for term, late preterm, very preterm, and extremely preterm babies, multiplied by 0.85.
  7. Discounted DALYs are computed from those month-1 conditional life expectancies at a 3% annual discount rate, and annual DALYs are then discounted by analysis year over the 10-year horizon.
  8. Costs include supplies per treated patient, oxygen per treated patient-day, nursing labor per treated patient-day, NICU cost per day, annualized device capital cost, and a counterfactual no-bCPAP oxygen cost for the share of RDS patients assumed to receive nasal cannula oxygen.

Annual Simulation Results

Metric Mean SD
Average annual RDS cases 273.94 16.67
Average daily NICU census 45.19 0.83
Average daily RDS cases present 3.75 0.24
Average annual RDS cases treated with bCPAP 263.89 14.06
Average annual RDS cases untreated 10.05 4.78
Average annual RDS deaths without bCPAP 64.38 3.92
Average annual RDS deaths with bCPAP 35.35 2.46
Average annual deaths averted 29.03 1.55
Average annual discounted DALYs averted 631.90 63.41
Average annual device utilization 0.542 0.030
Average annual oxygen cost (USD) 2,733.18 150.74
Average annual no bCPAP oxygen cost (USD) 947.05 62.82
Average annual nursing labor cost (USD) 593.14 32.71
Mean annual bCPAP program add-on cost per treated patient (USD) 20.88 0.38
Mean annual total bCPAP cost per RDS patient (USD) 120.16 2.91
Mean no bCPAP cost per RDS patient (USD) 103.49 2.78
Mean incremental cost per RDS patient (USD) 16.67 0.50
Mean incremental cost per NICU admission (USD) 1.382 0.050
Average annual incremental cost (USD) 4,559.71 168.24
Average annual discounted incremental cost (USD) 4,006.11 369.46

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_rds_patient_usd is the incremental cost difference between arms divided by the number of RDS patients. 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 0.542 means that roughly 4.33 devices are in use on an average day.

average_daily_nicu_census is the mean number of NICU admissions physically present in the unit on a given day. average_daily_rds_cases_present is the mean number of RDS cases present on a given day.

Daily RDS Census Distribution

The table below shows how many RDS cases were present on a typical day across all simulated years, summarized as average days per year and the share of days at each daily RDS census level.

rds_cases_present days_across_all_simulated_years average_days_per_year average_portion_of_days
0 86753 8.6753 0.0237679
1 322579 32.2579 0.0883778
2 603190 60.3190 0.1652575
3 753853 75.3853 0.2065351
4 705434 70.5434 0.1932696
5 529091 52.9091 0.1449564
6 332062 33.2062 0.0909759
7 178374 17.8374 0.0488696
8 83760 8.3760 0.0229479
9 35230 3.5230 0.0096521
10 13139 1.3139 0.0035997
11 4556 0.4556 0.0012482
12 1430 0.1430 0.0003918
13 419 0.0419 0.0001148
14 96 0.0096 0.0000263
15 24 0.0024 0.0000066
16 8 0.0008 0.0000022
17 2 0.0002 0.0000005