At the hospital where I am on staff, a total bilirubin test is included in our Chem 23 panel. The hospital charge for this test is $48.25. Usually, infants are monitored once a day for five days or until they leave the hospital. (No additional charge and no less charge if the bili was eliminated from the panel-- it's part of a package).
If a baby develops a bilirubin over 20, then an infant could be monitored by blood testing as often as every 4 hours.
So, for the great majority of infants, the total bilirubin test is part of the Chem 23, and thus is a throw in at no additional charge.
Most babies at home, do well and there would be little need for this test unless there was illness, or jaundice noticed by the mother. This would be rare once a child leaves the hospital.
In adults, jaundice can be caused by liver disease, and hemolytic anemia. We use a direct and indirect bilirubin to help with this diagnosis. Ordered separately, this fractionation cost is $19.06 (indirect)and $15.44 (direct).
I assume the instument in question measures jaundice, the breakdown products of hemoglobin that can be seen staining the skin. The color varies from yellowish-orange-greenish. I would doubt that the instrument would be useful for descrimination between indirect and direct hemoglobin.
It is possible that the instrument that CCSI proposes could reflect changes in skin color, and color density that could relate to actual serum levels of bilirubin.
Until there are controlled studies, clinical trials side by side with the current methodology, and more information provided by the company about this medical use, a lot of what I've read seems speculative.
Keep in mind that the routine screening test for bilirubin is done as part of a general screening test, and thus, even if the CCSI instrument could replace the bilirubin, there would be no fewer blood draws anyway, and the cost savings in this specific instance, would be zero. (Actually, there would be extra costs to a hospital for capitalization, and possibly the cost of nursing time spent performing the test).
In cases of more serious hyperbilirubinemia, it is possible that this method could be useful when blood tests are not being done. However, when bilirubin is elevated enough to be considered serious, more frequent blood test to monitor liver, and kidney function would be done anyway.
In summary, the CCSI instrument does not seem to be needed on a routine basis, but in rare, more serious cases in infants, it might be useful once the specificity and sensitivity of the machine are better known.
I hope that helps.
John |
