A COST COMPARISON ANALYSIS OF TWO LABORATORY ANALYTIC METHODS FOR BLOOD LEAD LEVELS IN YOUNG CHILDREN, RICHMOND, VA

Purpose: The study aims to calculate and compare the costs of screening for lead poisoning using two analytical methods, a point-of-care blood lead analysis (POC) versus an on-site filter paper blood collection with off-site laboratory analysis (FP) in Richmond, Virginia. 

Method: A decision-tree model was developed to calculate associated costs and outcomes of two screening methods. A cohort of Richmond children less than five years (N = 13,250) were followed from the point in time when they were screened by either the POC or the FP, to having a confirmatory venous test if the blood lead level (BLL) from the screening test was above 10 µg/dL. A child was identified as an elevated blood lead level (EBLL) child if the BLL from the venous test was above 10 µg/dL. The screening rates and probabilities for a child to arrive at different decision nodes were derived from a prospective study conducted in three Richmond, VA Women-Infants-Children (WIC) clinics. Cost data were either collected from the study sites or determined from Medicaid reimbursement rates in Virginia. Outcome measures were the number of children screened and the number of EBLL children identified. The analysis was conducted from the health system and societal perspectives. The base year of analysis was 2012. The final results are presented as average and incremental costs per child screened and per child with EBLL identified.

Result: The average costs per child screened were between US$ 17-23 by the FP and US$ 11-16 by the POC. The average costs per EBLL child identified were between US$ 243-343 by the FP and US$ 463-664 by the POC. The incremental costs of the POC in comparison with the FP were US$ 15 per child screened and US$ 943 per EBLL child identified from the societal perspective, and US$ 10 per child screened and US$ 654 per EBLL child identified from the health system perspective.

Conclusion: Costs were minimized by using the POC to screen Richmond children for lead poisoning, compared to the FP method. Therefore, the POC is a potentially viable method of helping to increase blood lead screening rates in WIC settings and to identify those with EBLL for intervention in Richmond, VA.