OBJECTIVE: Infants with mild hypoxic-ischemic encephalopathy (HIE) are at risk for neurodevelopmental impairment. Despite insufficient evidence, therapeutic hypothermia (TH) has become more prevalent over time in the management of infants with mild HIE, but treatment remains controversial and inconsistent. This research aims to determine the cost-effectiveness of TH for neonates with mild HIE compared to standard care (normothermia).

METHODS: A hybrid decision tree and Markov model was created to estimate the incremental costs and benefits of TH in a theoretical cohort of infants with mild HIE. We undertook a U.S. societal perspective over a lifetime and used a 5% discount rate. All costs were expressed in 2021 US dollars, and we set a willingness to pay (WTP) threshold of $100,000 per quality-adjusted life year (QALY). The incremental cost-effectiveness ratio (ICER) was determined (cost/QALY) for infants who received TH vs. standard care. Model inputs were derived from the literature and the Pediatric Health Information System database. Deterministic and probabilistic sensitivity analyses were performed to interrogate model assumptions.

RESULTS: The ICER of TH compared to standard care was $10,927/QALY and $8,767/QALY using deterministic and probabilistic analyses, respectively. Monte Carlo simulations showed that TH was cost-effective compared to standard care 65% of the time at the given WTP threshold. Additional analyses performed using fixed probabilities of disability found that the probability of TH being cost-effective exceeds 90% when the probability of disability after TH is <7%.

CONCLUSION: Our model suggests TH may be a cost-effective treatment for infants with mild HIE. Given the significant variation in incremental costs and benefits, further longitudinal studies are needed to evaluate the long-term outcomes and resource utilization of this population.