Surfactant replacement therapy—economic impact

Abstract

Surfactant replacement is an effective treatment for neonatal respiratory distress syndrome. (RDS). As widespread use of surfactant is becoming a reality, it is important to assess the economic implications of this new form of therapy. A comparison study was carried out at the Neonatal Intensive Care Unit (NICU) of Northwest Armed Forces Hospital, Saudi Arabia. Among 75 infants who received surfactant for RDS and similar number who were managed during time period just before the surfactant was available, but by set criteria would have made them eligible for surfactant. All other management modalities except surfactant were the same for all these babies. Based on the intensity of monitoring and nursing care required by the baby, the level of care was divided as: Level IIIA, IIIB, Level II, Level I. The cost per day per bed for each level was calculated, taking into account the use of hospital immovable equipment, personal salaries of nursing, medical, ancillary staff, overheads and maintenance, depreciation and replacement costs. Medications used, procedures done, TPN, oxygen, were all added to individual patient's total expenditure. 75 infants in the Surfactant group had 62 survivors. They spent a total of 4300 days in hospital. (av 69.35) Out of which 970 d (av 15.65 per patient) were ventilated days. There were 56 survivors in the non-surfactant group of 75. They had spent a total of 5023 days in the hospital (av 89.69/patient) out of which 1490 were ventilated days (av 26.60 d). Including the cost of surfactant (two doses), cost of hospital stay for each infant taking the average figures of stay would be SR 118, 009.75 per surfactant treated baby and SR 164, 070.70 per non-surfactant treated baby. The difference of 46,061 SR is 39.03% more in non-surfactant group. One Saudi rial = 8 Rs (approx at the time study was carried out.) Medical care cost varies from place to place. However, it is definitely cost-effective where surfactant is concerned. Quality adjusted life years (QALY) for NICU care compares favourably with cost per QALY of several forms of adult health interventions. Audit, both medical and financial, of these services, at regular intervals is essential.

State of health economic evaluation research in Saudi Arabia: a review

“…In two papers,8,15 the aim did not contain any reference to measurement of cost, cost-effectiveness, or cost-benefit. In the remaining papers, the aim was to assess cost-effectiveness (n = 4),9,13,14,16 cost-benefit (n = 1),12 or compare costs with outcomes (n = 3) 10,11,17. Eight studies compared two alternatives and one compared three alternatives.…”

“…As Table 1 shows, six of the included studies collected effectiveness measures using a prospective design,9–13,17 three using pre-intervention and post-intervention design,8,15,16 and one using a retrospective design 14. Only one study calculated a sample size 12.…”

“…Only one study calculated a sample size 12. The study periods were one year or less (n = 5),8,9,11,12,17 two years (n = 2),15,16 six years (n = 1),13 and eight years (n = 1) 14. One study projected outcomes and costs over 40 years using a Markov modeling technique 10.…”

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

“…Cost-effectiveness models and analyses of interventions to improve perinatal and neonatal outcomes have been infrequently applied in emerging economies 684 and are rarer still in developing countries. Examples of costeffectiveness assessment of intervention strategies in developing countries have largely included hospitalbased interventions such as routine ultrasonogra- phy, 685 surfactant replacement therapy, 686 prevention of respiratory syncytial virus infections, 687 and (more recently) the successful WHO-modified antenatal care package. 84,688 In other instances, organization of basic neonatal care services in referral hospitals has been shown to be cost-effective.…”

Pharmacoeconomics of Surfactant Therapy

“…Similar to the studies previously discussed, all inpatient hospital costs associated with the treatment of premature infants were considered. 8 In addition to the positive therapeutic outcomes (lower length of hospital stay, increased survival, and decreased ventilation days), the costs associated with surfactant treatment were found to be 39% lower than the control group.…”