Two-way sensitivity analysis on cord blood intervention efficacy and cost.
DukeACT
This figure shows the effect of varying CB intervention efficacy and cost on cost-effectiveness outcomes. CB intervention efficacy on VABS-3 communication subscale score was varied across the Y-axis, from a mean change of 1.0–6.0. CB intervention cost was varied across the X-axis, ranging from $3,000-$33,000. The projected ICER of each combination of efficacy and cost are shown in the Figure and are color coded: green indicates an ICER <$50,000/QALY, yellow an ICER between $50,000–100,000/QALY, orange between $100,000–150,000/QALY, and red >$150,000/QALY (Legend). The white star indicates the projected cost-effectiveness of DukeACT intervention basecase parameters. CB: cord blood, VABS: Vineland Adaptive Behavior Scale, ICER: incremental cost-effectiveness ratio.To create a best-case scenario, we simultaneously varied CB cost to $8,000, efficacy to a VABS communication increase of 6.0, beta parameter to 0.0074, and productivity benefits to 60%. With these assumptions, the CB intervention ICER lowered to $8,000/QALY. In the worst-case scenario (that may be expected with a waning intervention that requires several additional doses), we varied CB cost to $45,000, efficacy to a VABS-3 communication increase of 1.0, beta parameter to 0.0019, and productivity benefits to 0%, yielding an ICER of $2,387,000/QALY. We acknowledge that a worst-case scenario might also include a CB efficacy of 0, under which CB would be an inefficient use of resources.