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Cost implications of different approaches to the prevention of respiratory distress syndrome
M Mugford1, J Piercy, I Chalmers
1National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford.
Insights
Preventive policies like corticosteroids and surfactant therapy can reduce neonatal respiratory distress syndrome and mortality. Adoption of these treatments can decrease overall neonatal care costs by 1-10% and cost per survivor by up to 16%.
Area of Science:
- Neonatal Medicine
- Health Economics
- Perinatal Care
Background:
- Neonatal respiratory distress syndrome (RDS) and mortality are significant concerns in preterm infants.
- Corticosteroid administration to mothers delivering preterm and surfactant therapy for at-risk infants are established preventive measures.
- The economic impact of implementing these evidence-based neonatal care policies requires thorough evaluation.
Purpose of the Study:
- To assess the cost-effectiveness of adopting corticosteroid and/or surfactant preventive policies for neonatal care.
- To determine the impact of these policies on overall neonatal care costs and cost per survivor.
Main Methods:
- Treatment effect estimations derived from systematic reviews of relevant controlled trials.
- Cost estimations based on observational data from a single neonatal intensive care unit.
- Economic modeling to project costs under different policy adoption scenarios and drug price points.
Main Results:
- Adopting either policy for infants <35 weeks' gestation, with drug costs ≤£150/baby, could reduce overall neonatal care costs by 1-10%.
- Cost per survivor could decrease by up to 16%, even with drug costs as high as £550/baby.
- For infants <31 weeks' gestation, policies reduce cost per survivor by 5-16%, but may increase overall costs by 7-32% due to improved survival.
Conclusions:
- Implementing corticosteroid and surfactant therapies represents a cost-effective strategy in neonatal care, particularly for reducing the cost per survivor.
- While overall costs may increase for the most premature infants (<31 weeks) due to enhanced survival, the reduction in cost per survivor is significant.
- These findings support the widespread adoption of preventive policies for preterm infants to optimize resource allocation in neonatal intensive care.
Abstract:
Because the incidence of both neonatal respiratory distress syndrome and neonatal mortality can be reduced by giving corticosteroids to women expected to deliver preterm and by giving surfactant to babies at high risk of developing hyaline membrane disease, we have considered what effects the adoption of one or both of these preventive policies would have on the costs of neonatal care. We have estimated the effects of treatment from overviews of the relevant controlled trials, and estimated costs from observations of care at one neonatal unit. Our results suggest that if either of these policies is adopted for all babies under 35 weeks' gestation at a drug cost of 150 pounds or less/baby, the overall costs of care would be reduced by between 1 and 10%. The cost per survivor would be reduced by up to 16% even if the drug cost were to be as high as pounds 550/baby. If the policies were to be adopted only for babies under 31 weeks' gestation, both policies would result in a reduction in cost of between 5 and 16%/survivor, although the increased survival resulting from the policies would lead to an increase in overall costs for babies of less then 31 weeks' gestation of between 7 and 32%.
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