An Open Label Comparison of Calfactant and Poractant Alfa Administration Traits and Impact on Neonatal Intensive Care Unit Resources

Abstract

OBJECTIVE To compare calfactant (CA) and poractant alfa (PA) administration traits, short-term clinical responses, and resource use in the neonatal respiratory distress syndrome (RDS) setting. METHODS An open label series of 277 (213 PA and 64 CA) infants was evaluated for 445 administrations. Registered respiratory therapists collected patient, surfactant administration, and postadministration clinical data. Economic analysis involved labor costs of surfactant administration and usage, wastage, and product average wholesale price. Analysis utilized the Mann-Whitney rank sum test for differences in administration time and either the chi-square or Fisher's exact test for categorical variables. RESULTS PA had a statistically lower bedside administration time than CA (3.8 minutes vs. 5.3 minutes; P = .006) and a higher percentage of doses administered in less than five minutes (58.9% vs. 4.3%; P < .001). Doses administered per patient were similar (1.67 vs. 1.72). PA and CA were similar in time to recovery (81.4% vs. 74.3%), percent desaturation (24.8% vs. 26.7%), and bradycardia (3.8% vs. 8.5%). Reflux was significantly higher (13.2% vs. 3.5%; P < .001) with CA. Economic analyses found total administration costs per dose were $2.21 for PA and $3.08 for CA. Mean wastage costs were $141.21 for PA and $337.34 for CA (P < .001). CONCLUSIONS PA appeared to utilize fewer neonatal intensive care unit resources than CA due to reduced administration time and less wastage of drug product. Future studies should more closely evaluate time, resource, wastage, and post-administrative clinical effects to fully assess the impact of surfactant products in this setting.

Comparison of the Pharmacoeconomics of Calfactant and Poractant Alfa in Surfactant Replacement Therapy

“…The similarity of the pattern of usage between calfactant and poractant alfa observed in this report replicates 1 of the 2 previous reports comparing the usage be-tween these 2 surfactants. In addition to Jeon et al, 11 Gerdes et al 12 reported calfactant patients averaging 1.72 doses and poractant alfa patients averaging 1.67 doses. 12 The Gerdes et al 12 experience is almost identical to the average per patient dosing of 1.6 for calfactant patients and 1.7 for poractant alfa patients observed in this experience.…”

Pharmacoeconomics of Surfactant Therapy

“…11 Very low birth weight infants were enrolled in a sequential, non-randomized, open label fashion at a major teaching hospital. In the 31-month study period, poractant alfa was used for the first 23 months, and calfactant was used for the latter 8 months.…”

Choosing a Right Surfactant for Respiratory Distress Syndrome Treatment

“…Gerdes et al [31] in an open-label comparison of calfactant with poractant 4 alfa showed cost benefits favoring poractant alfa. In a cost-minimization analysis comparing poractant alfa and beractant, Marsh et al [32] reported significant cost savings with poractant alfa treatment compared to beractant.…”

“…Ten studies have compared the three natural surfactants, eight [24][25][26][27][28][29] were randomized controlled trials and two were retrospective studies [30,31] . Four of the eight trials compared beractant with calfactant and the other four trials compared beractant with poractant alfa.…”