Pharmacoeconomics of Surfactant Therapy

Abstract

Surfactant therapy has become an integral part of the standard of care for treating premature infants with respiratory distress syndrome (RDS). Institutions that routinely treat this patient population have to select a surfactant based upon clinical and pharmacoeconomic considerations. Pharmacoeconomic studies have established the cost-effectiveness of individual agents based on a variety of factors, including length of hospitalization, mortality odds ratio, and other direct medical costs. These studies evaluated infants with weights between 600 and 2000 grams and survival periods between 28 days and 1 year. With the cost-effectiveness of surfactants already established as being far superior to no treatment, trials have evolved to compare the available surfactants. Two studies have supported the cost-effectiveness of beractant compared to colfosceril or calfactant. Two others demonstrated lower resource utilization associated with poractant alfa as compared to beractant or calfactant. Evolving treatment approaches in the management of neonatal RDS, such as recent data suggesting continuous positive airway pressure as an alternative to mechanical ventilation for respiratory support, have defined the need to further evaluate the impact of such strategies upon surfactant and resource utilization.

Neurodevelopmental Outcomes of Very Low Birth Weight Preterm Infants Treated With Poractant Alfa versus Beractant for Respiratory Distress Syndrome

“…Treatment with poractant alfa was associated with lower mortality, redosing, risk of BPD, and cost compared with beractant. 4, [10][11][12][13]18,19 To our knowledge, previous poractant alfa and beractant comparison trials have not reported long-term outcomes beyond the neonatal period. This may limit the ability to draw conclusions related to the impact of poractant alfa on long-term morbidity after discharge from the NICU.…”

“…Prospective randomized trials as well as large retrospective studies have shown significant differences in short-term outcomes and cost among these surfactants. 4, [7][8][9] Treatment with poractant alfa is associated with lower mortality 10,11 and significant cost benefits 12,13 compared with beractant. Similarly, Dizdar et al reported that treatment with poractant alfa decreases redosing, enables rapid extubation, and decreases the risk of bronchopulmonary dysplasia (BPD) compared with beractant in preterm infants.…”

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

“…The introduction of surfactant in clinical practice has significantly reduced the perinatal mortality and cost of care of extremely premature infants. 14,28 Large studies 29,30 looking at the LOS, mortality, and the cost of care are few as a result of difficulties in performing such studies prospectively. Therefore, retrospective database studies such as this are useful in gathering large amounts of clinical data in order to perform robust statistical analyses and to derive meaningful information from different NICU settings.…”