Health Economics and Outcomes of Surfactant Treatments for Respiratory Distress Syndrome Among Preterm Infants in US Level III/IV Neonatal Intensive Care Units

Abstract

OBJECTIVE To compare length of stay (LOS), costs, mechanical ventilation (MV), and mortality in preterm infants treated in the Neonatal Intensive Care Unit (NICU) with beractant (BE), calfactant (CA), and poractant alfa (PA) for Respiratory Distress Syndrome (RDS). METHODS This study evaluated preterm infants born between 2010 and 2013 with RDS diagnosis, gestational age of 25 to 36 weeks, birthweight of ≥500 g, and age of ≤2 days on first surfactant administration. Multivariable regression was used to evaluate all NICU outcomes. RESULTS Of 13,240 infants meeting the study criteria, 4136 (31.2%) received BE, 2502 (18.9%) received CA, and 6602 (49.9%) received PA. Adjusted analyses estimated similar mean LOS (BE 26.7 days, CA 27.8 days, and PA 26.2 days) and hospital costs (BE: $50,929; CA: $50,785; and PA: $50,212). Compared to PA, BE and CA were associated with greater odds of MV use on day 3 (OR = 1.56 and 1.60, respectively) and day 7 (OR = 1.39 and 1.28, respectively; all p < 0.05). Adjusted NICU mortality was significantly higher only with CA vs PA (OR = 1.51; p = 0.015). CONCLUSION Adjusted NICU LOS and costs were similar among BE, CA, and PA. Infants receiving PA were less likely to be on MV at 3 and 7 days, and PA treatment was associated with lower odds of NICU mortality when compared to CA.

Optimal Ventilation and Surfactant Therapy in Very-Low-Birth-Weight Infants in Resource-Restricted Regions

“…In RRR, the choice of surfactant is often based on pharmaceutical and financial accessibility. The type of surfactant used in RDS may be immaterial, with similar clinical outcomes and financial implications [26]. A comparison of beractant with poractant alfa, combined with nCPAP, in an RRR showed no differences in a combined outcome of death/bronchopulmonary dysplasia or other short-term outcomes [27] (Table 2).…”

Surfactant Stock Optimization for Cost Minimization in Neonatal Intensive Care Units

“…Surfactant treatments on patients are evaluated by cost per patient, factors that affect costs, and benchmark results. Marsh et al [ 1 ]; Brown et al [ 12 ], Zayek et al [ 13 ]; and Sekar et al [ 14 ] obtained different results in their assessments for the effective cost. Some studies focused on beractant and poractant.…”

“…When Zayek et al [ 13 ] evaluated calfactant and poractant in their study, they concluded that calfactant is cost-efficient. Sekar et al [ 14 ] concluded that the cost-effectiveness analysis of calfactant, poractant, and beractant is close, but beractant has a lower cost.…”

“…Brown et al [ 12 ] and Sekar et al [ 14 ] both assessed clinical benefits and cost-effectiveness. Brown et al [ 12 ] put forward that clinical evaluations of poractant and beractant show that poractant is more efficient in terms of the duration of hospital stay and respiratory support.…”

“…Brown et al [ 12 ] put forward that clinical evaluations of poractant and beractant show that poractant is more efficient in terms of the duration of hospital stay and respiratory support. Sekar et al [ 14 ] studied the clinical superiority of calfactant, poractant, and beractant and concluded that calfactant has a lower mortality rate. Poractant and beractant have equal mortality rates, but in ventilation, poractant has superiority.…”