Cost-effectiveness of skin-barrier-enhancing emollients among preterm infants in Bangladesh

Abstract

Objective To evaluate the cost-effectiveness of topical emollients, sunflower seed oil (SSO) and synthetic Aquaphor, versus no treatment, in preventing mortality among hospitalized preterm infants (< 33 weeks gestation) at a tertiary hospital in Bangladesh. Methods Evidence from a randomized controlled efficacy trial was evaluated using standard Monte Carlo simulation. Programme costs were obtained from a retrospective review of activities. Patient costs were collected from patient records. Health outcomes were calculated as deaths averted and discounted years of life lost (YLLs) averted. Results were deemed cost-effective if they fell below a ceiling ratio based on the per capita gross national income of Bangladesh (United States dollars, US$ 470). Findings Aquaphor and SSO were both highly cost-effective relative to control, reducing neonatal mortality by 26% and 32%, respectively. SSO cost US$ 61 per death averted and US$ 2.15 per YLL averted (I$ 6.39, international dollars, per YLL averted). Aquaphor cost US$ 162 per death averted and US$ 5.74 per YLL averted (I$ 17.09 per YLL averted). Results were robust to sensitivity analysis. Aquaphor was cost-effective relative to SSO with 77% certainty: it cost an incremental US$ 26 more per patient treated, but averted 1.25 YLLs (US$ 20.74 per YLL averted). Conclusion Topical therapy with SSO or Aquaphor was highly cost-effective in reducing deaths from infection among the preterm neonates studied. The choice of emollient should be made taking into account budgetary limitations and ease of supply. Further research is warranted on additional locally available emollients, use of emollients in community-based settings and generalizability to other geographic regions.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬

Effect of emollient therapy on clinical outcomes in preterm neonates in Pakistan: a randomised controlled trial

“…The trial demonstrated the lifesaving potential of emollient use and its cost effectiveness. The incremental cost to achieve these results was US$2.15 per year of life lost averted and US$61.00 per death averted, making it one of the most cost-effective interventions available 26. A hospital-based study in India also showed significantly greater mean daily weight gain (2.54 g, 95% CI 1.33 g to 3.75 g) among preterm infants receiving emollient therapy with CO compared with mineral oil 19.…”

Neonatal hypothermia in low resource settings: a review

“…69 In randomized, controlled trials in hospitals in Egypt and Bangladesh, sunflower seed oil applications reduced the incidence of neonatal sepsis by about 40 to 50%, 5,81 and in Bangladesh they reduced the risk of mortality by 26%. 82 Thus, evidence exists to promote the use of this highly cost effective intervention 102 in hospitalized, preterm infants <33 weeks gestational age in low resource settings. However, further research is needed on the impact of this intervention in all newborns (that is, both term and preterm infants) in the hospital, and no data exist on the impact of this intervention in community settings.…”

Alternative Medicine in Pediatric Dermatology: What Is the Evidence?

“…In a randomized study of 497 preterm neonates in Bangladesh, thrice-daily topical application of sunflower seed oil significantly reduced sepsis and mortality rates by 41 and 26 %, respectively, both significantly higher than the untreated control [14,15]. In reducing sepsis rates, sunflower seed oil actually slightly outperformed a petroleum-based emollient and at a vastly lower cost [16]. These studies support a possible role for sunflower seed oil in treating diseases of skin-barrier dysfunction, including atopic dermatitis.…”