Cost Effectiveness of Neonatal Resuscitation at 22 Weeks of Gestation

Abstract

To evaluate the cost effectiveness of three different approaches to the care of neonates born at 22 weeks of gestation: universal resuscitation, selective resuscitation, or no resuscitation. METHODS:We constructed a decision-analytic model using TreeAge to compare the outcomes of death and survival with and without neurodevelopmental impairment in a theoretical cohort of 5,176 neonates (an estimate of the annual number of deliveries that occur in the 22nd week of gestation in the United States). We took a societal perspective using a lifetime horizon, and all costs were expressed in 2017 U.S. dollars. Effectiveness was based on combined maternal and neonatal quality-adjusted life years (QALYs). The incremental costeffectiveness ratio was determined (cost/QALY) for each additional survivor. The willingness to pay threshold was set at $100,000/QALY. All model inputs were derived from the literature. Deterministic and probabilistic sensitivity analyses were performed to interrogate model assumptions.RESULTS: Universal resuscitation would result in 373 survivors, 123 of whom would have severe disability. Selective resuscitation would produce 78 survivors with 26 affected by severe impairments. No resuscitation

Case Report: Treatment of Extremely Preterm Infants With Birthweight Below 300 g: Case Series

“…The answers to the question "How small is too small?" should always change with time and place, according to the medical standard, socioeconomic status, culture of each region, and so on (27)(28)(29)(30)(31)(32). In Japan, an approach of universal resuscitation is favored for neonates at 22 and 23 weeks of gestation, although the definitive criteria on the threshold of birthweight for resuscitation remain unestablished.…”

“…Similarly, the 2010 American Heart Association guidelines on neonatal resuscitation proposed that the threshold for withholding resuscitation might be GA <23 weeks or birthweight <400 g (29)(30)(31). Leah et al reported that neither selective nor universal resuscitation at 22 weeks of gestation is cost-effective compared with no resuscitation (32).…”