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Cost-effectiveness of prophylactic indomethacin in very-low-birth-weight infants
Martin P Moya1, Ronald N Goldberg
1Department of Pediatrics, Division of Neonatology, Duke University Medical Center, Durham, NC, USA. mmoya@vitametrix.com
Insights
Prophylactic indomethacin use in preterm infants is cost-effective, improving quality-adjusted life years (QALYs) and reducing overall costs. This approach is favored for preventing patent ductus arteriosus (PDA) and intraventricular hemorrhage (IVH).
Area of Science:
- Neonatal medicine
- Pharmacoeconomics
- Clinical trial analysis
Background:
- Patent ductus arteriosus (PDA) and intraventricular hemorrhage (IVH) are significant concerns in preterm infants.
- Indomethacin is a pharmacological agent used to manage these conditions.
- Cost-effectiveness of indomethacin requires thorough evaluation for clinical decision-making.
Purpose of the Study:
- To conduct a cost-effectiveness analysis of indomethacin use in preterm infants.
- To evaluate the impact of indomethacin on PDA, IVH, and mortality.
- To inform decisions regarding the prophylactic use of indomethacin.
Main Methods:
- A comprehensive literature search of RCTs, cohort, and case-control studies was performed (1966-2000).
- A decision tree model was developed to assess costs and outcomes.
- Sensitivity analysis was employed to address uncertainties in probability data.
Main Results:
- Indomethacin use resulted in higher quality-adjusted life years (QALYs) compared to the control group (11 vs. 10 years).
- The total cost for indomethacin treatment was lower than the control group ($95,157 vs. $99,955).
- Cost-effectiveness per QALY was favorable for indomethacin ($8443 vs. $9168).
Conclusions:
- Prophylactic indomethacin administration is both less costly and more effective in preterm infants.
- The analysis indicates a favorable economic profile for early indomethacin use.
- Potential confounding factors like antenatal steroid use and renal toxicity warrant further investigation.
Objective:
To perform cost-effectiveness analysis to facilitate the decision-making process surrounding use of indomethacin in preterm infants to lower the incidence of patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH), and death.
Methods:
A MEDLINE literature search from 1966 to July 2000 was performed to identify relevant randomized, controlled trials (RCTs), as well as cohort and retrospective case-control studies. A decision tree was built representing the choice to use or not use indomethacin, and the potential outcome costs. Probabilities of being in each chance node were obtained from this search. Where data probabilities were not clear, a sensitivity analysis was conducted.
Results:
There was no difference in the expected survival per year; however, there was a significant difference when effectiveness was measured as quality-adjusted life years (QALYs), resulting in 11 and 10 years for the indomethacin and control groups, respectively. The indomethacin treatment cost was $95,157 and that of the control groups was $99,955. The cost effectiveness per life expectancy of being in the indomethacin and control groups was $7142 and $7727, respectively. The sensitivity analysis for PDA closure and prevention of IVH for infants eventually developing PDA versus those without PDA showed no difference. The cost-effectiveness analysis per QALY was $8443 for the indomethacin treatment and $9168 for the control group.
Conclusions:
The prophylactic use of indomethacin is less costly and more effective within an important range of certainty. However, this analysis does not include several potentially confounding factors, such as antenatal steroid use or indomethacin-induced renal toxicity. Depending on the frequency with which these factors arise, economic projections may be considerably altered against the early use of indomethacin.