Despite the high costs that jaundice put upon the country's health sector every year, no study has been conducted to measure the cost-effectiveness of phototherapy at home compared to phototherapy in hospitals around the world. However, it seems that the economic burden of this disease can lead to high costs, especially in low-income families. The results of studies also show that problems such as frequent visit of laboratories for blood sampling, mental and physical stress imposed on parents and the risk of brain damage due to not getting back to repeat the tests and treatment can be easily reduced by performing phototherapy at home (29). Thus, this study was conducted to assess the cost-effectiveness of phototherapy at home compared to phototherapy in the hospital. We hope that the results of this study can provide guidelines for health specialists and policymakers in allocating financial and human resources and in paying more attention to a more effective control and treatment program for pediatric jaundice.
According to the findings of the present study, phototherapy at home costs an average of $ 196.52, while phototherapy in the hospital costs an average of $ 397.85. Therefore, the average cost of treatment for each patient treated with phototherapy at home is less than the method of treatment with phototherapy in the hospital. One of the reasons for this difference is the very high cost of a hospital bed.
Golshan Tafti and Golzari (2018) showed that despite the same reduction of bilirubin and the same complications of phototherapy in the two groups of phototherapy (home and hospital), the period and the cost of treatment in home-treated phototherapy was significantly lower than in-hospital phototherapy ($ 3121 compared to $ 5192) (29). Peterson et al. (2021) also showed that home phototherapy was less expensive than in-hospital phototherapy ($ 13,491 in home phototherapy versus $ 1101 in hospital phototherapy) (30). In addition, according to Jackson et al. (2000) treatment of patients at home led to an acceptable reduction in serum bilirubin and none of them needed to be readmitted to the hospital for phototherapy. Their families were very satisfied with the phototherapy at home and they had a significant reduction in the cost of phototherapy. So, home phototherapy was affordable and safe for families (31). Findings of all the three studies are consistent with the results of the present study, which makes sense to use phototherapy at home to avoid additional costs associated with hospitalization and the related services.
In this study, the effectiveness was evaluated based on the average bilirubin reduction. According to the results, phototherapy at home has caused a greater reduction in bilirubin in patients than phototherapy in the hospital. Statistical tests showed that there is a statistically significant difference between the effectiveness of phototherapy at home and in the hospital.
In a meta-analysis study, Yangchu et al. (2020) concluded that compared to nosocomial phototherapy, home phototherapy is more effective in treating neonatal hyperbilirubinemia and reducing total serum bilirubin. However, there is no significant difference in duration of phototherapy in the two groups (14), which is similar to the findings of our study.
Also, according to Khatami et al. (2007), home phototherapy, if performed under the supervision of experienced medical and nursing staff, in 92.6 cases can be a suitable and effective alternative method for the treatment of mature and healthy infants with indirect jaundice and has benefits such as lower cost, not separating mother from baby and no feeling of illness in the baby (15), which in this regard is also consistent with the present study.
Barzegar et al. (2005) but showed that there is no significant difference between the two groups in terms of reducing bilirubin levels (22), which is not consistent with our study.
Increased cost-effectiveness ratio (ICER) was used to analyze cost data in two groups of phototherapy at home and in hospital. According to the findings of the study, phototherapy at home is less expensive (196.52 vs. $ 397.85) and more effective (0.39 vs. 0.36) than phototherapy in the hospital, so it is the dominant mode and a more cost-effective option. .
Tiberg et al. (2016) in a study on children with type 1 diabetes concluded that there was a statistically significant difference in relation to health care satisfaction in favor of home care (p = 0.002). Overall, health care costs (direct costs) were significantly lower in the home care group, but there was no statistically significant difference between the two groups in estimating lost production (indirect costs) for the family as a whole. In total, the results showed that home care may be a cost-effective strategy using the perspective of the health care sector, but when using a broader social perspective, no difference was found in cost-effectiveness or cost-desirability (32). The results of this study are also consistent with the present study in terms of cost-effectiveness of home care.
Maru et al. (2015) in research on chronic heart failure (CHF) patients in Australia found that on the verge of willingness to pay a $ 50,000 for each additional QALY, the likelihood of having a better evaluation for home care by heart failure patients was 96% and the increasing net monetary benefit (NMB) was a $ 24,342 (5% off) for home care. They concluded that home care for elderly CHF patients is significantly cost-effective (33). The results of this study are consistent with the present study in terms of cost-effectiveness of home care.
Ghaderi et al. (2013) examined the cost-effectiveness of home care and hospital care for stroke patients and found that the home care system for stroke patients is a suitable substitute for hospitalization of these patients. This issue is more important due to Iran's lack of beds and hospitals and should be considered by policy makers (34).
Moalosi et al. (2003) also found in a study on tuberculosis patients in Botswana that, in general, home care reduced the cost per treated patient by 44% compared to treatment in hospital ($ 1657 vs. $ 2970), and the cost of the health system fell by 50% ($ 1106 vs. $ 2206). Finally, they concluded that home care is more acceptable and cost effective than hospital care for patients with chronic tuberculosis (35). The results of this study in terms of cost-effectiveness of home care is consistent with the present study.
The results of one-way sensitivity analysis showed that in the cost-effectiveness analysis, the ICER rate was negative, and the highest sensitivity to the effectiveness of the treatment was on the second day. Given that in the cost-effectiveness sensitivity analysis, the ICER value remains negative, so it can be said that the results of the study have the necessary strength. The results of probabilistic sensitivity analysis showed that home phototherapy is the most cost- effective treatment in 95.28% of simulation cases for a threshold of less than $ 13,116. The findings from the distribution curve showed that phototherapy at home was more effective and less costly in 63.04 cases. Although in 32.24% of cases it was less effective, it had a much lower cost, which was finally below the threshold. Therefore, the results revealed that performing sensitivity analysis did not change the status of phototherapy strategy at home as the most effective strategy and this is a sign of the strength of the study results.
One limitation of the present study was the self-reporting of non-medical direct costs and indirect costs by patients or their companions, who were more likely to forget or tell the approximate amount of the costs. Additionally, in this study, intangible costs were not calculated due to the inability to measure them accurately.