Objective To assess the cost‐effectiveness of treatment with nifedipine compared with atosiban in women with threatened preterm birth. Design An economic analysis alongside a randomised clinical trial (the APOSTEL III study). Setting Obstetric departments of 12 tertiary hospitals and seven secondary hospitals in the Netherlands and Belgium. Population Women with threatened preterm birth between 25 and 34 weeks of gestation, randomised for tocolysis with either nifedipine or atosiban. Methods We performed an economic analysis from a societal perspective. We estimated costs from randomisation until discharge. Analyses for singleton and multiple pregnancies were performed separately. The robustness of our findings was evaluated in sensitivity analyses. Main outcome measures Mean costs and differences were calculated per woman treated with nifedipine or atosiban. Health outcomes were expressed as the prevalence of a composite of adverse perinatal outcomes. Results Mean costs per patients were significantly lower in the nifedipine group [singleton pregnancies: €34,897 versus €43,376, mean difference (MD) −€8479 [95% confidence interval (CI) −€14,327 to −€2016)]; multiple pregnancies: €90,248 versus €102,292, MD −€12,044 (95% CI −€21,607 to € −1671). There was a non‐significantly higher death rate in the nifedipine group. The difference in costs was mainly driven by a lower neonatal intensive care unit admission (NICU) rate in the nifedipine group. Conclusion Treatment with nifedipine in women with threatened preterm birth results in lower costs when compared with treatment with atosiban. However, the safety of nifedipine warrants further investigation. Tweetable abstract In women with threatened preterm birth, tocolysis using nifedipine results in lower costs when compared with atosiban.
Nifedipine maintenance tocolysis is not associated with improved perinatal outcome or pregnancy prolongation.
Background and AimsThe Bayley Scales of Infant Development (BSID) is the most widely used measure to assess neurodevelopment of very preterm (gestational age ≤32 weeks) and very low birth weight (VLBW, ≤1500grams) infants in the first three years of life. This meta-analysis determines the predictive value of the mental subscale (MDI) and motor subscale (PDI) of the BSID for later (≥36 months) motor and cognitive development in very preterm/ VLBW children. Methods PubMed, PsychINFO and CINAHL were searched for English-language peer-reviewed studies published before April 2012. Studies were included if they reported odds ratios or correlations between the MDI/PDI scores obtained in the first three years of life, and standardized intelligence or motor assessment in childhood (≥36 months of age). Meta-analytic methods were applied to aggregate available data. Results A total of 16 studies met inclusion criteria. Across 15 studies encompassing 1335 very preterm/VLBW children, MDI scores were strongly predictive for later cognitive development, r=0.61 (95%CI: 0.57-0.64), p<0.001. The relationship between MDI scores and later cognitive development was not mediated by birth weight (p=0.56), gestational age (p=.70), and time interval between assessments (p=0.55). Across four studies including 465 very preterm/ VLBW children, PDI scores were moderately predictive for later motor function, r=0.32 (95%CI: 0.22-0.40), p<0.001. Conclusions In very preterm/VBLW children, MDI scores explain 37% of the variance in later cognitive functioning, whereas PDI scores explain 10% of later motor development. Thus a large proportion of the variance remains unexplained, underlining the importance of enhancing prediction of developmental outcomes.
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