Antenatal corticosteroid administration in late-preterm gestations: a cost-effectiveness analysis

Area of Science:

• Neonatal Medicine
• Health Economics
• Pharmacoeconomics

Background:

• Late-preterm infants (34-36 weeks gestation) face risks like respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), and hypoglycemia.
• Antenatal corticosteroids, such as betamethasone, are used to mature fetal lungs but their cost-effectiveness in the late-preterm period is debated.

Purpose of the Study:

• To evaluate the cost-effectiveness of administering antenatal late-preterm betamethasone in the immediate neonatal period.
• To analyze the economic impact and clinical outcomes associated with this intervention.

Main Methods:

• A cost-effectiveness analysis was performed from a health-system perspective with a 7.5-day time horizon.
• Data on neonatal outcomes (RDS, TTN, hypoglycemia) were sourced from the Antenatal Betamethasone for Women at Risk for Late-Preterm Delivery trial.
• Cost data were obtained from the Healthcare Cost and Utilization Project, and neonatal outcome utilities were from existing literature.

Main Results:

• For individual infants, betamethasone administration resulted in higher costs ($6592 vs. $6265) and marginally lower quality-adjusted life years (QALYs) compared to withholding it.
• For a cohort of 270,000 late-preterm infants, betamethasone increased total costs by $88 million and resulted in fewer QALYs.
• Cost-effectiveness would require hypoglycemia, RDS, or TTN rates below 20.0%, 4.5%, or 2.4%, respectively, in infants receiving betamethasone.

Conclusions:

• The administration of antenatal betamethasone in the late-preterm period is unlikely to be cost-effective in the short term.
• Current evidence suggests potential economic and QALY disadvantages for this intervention in the immediate neonatal period.