Antenatal corticosteroid administration in late-preterm gestations: a cost-effectiveness analysis

Rosenbloom, Joshua I.; Lewkowitz, Adam K.; Sondgeroth, Kristina E.; Hudson, Jessica; Macones, George A.; Cahill, Alison G.; Tuuli, Methodius G.; Chang, Su‐Hsin

doi:10.1080/14767058.2018.1540582

Cited by 4 publications

(11 citation statements)

References 32 publications

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“…However, a recent cost-effectiveness analysis based on aggregate data from the ALPS trial used trial secondary outcomes of transient tachypnea of the newborn and respiratory distress syndrome as the measure of effectiveness. 36 The authors did not assess the primary outcome. Because the parent trial found no difference in respiratory distress syndrome, any model of costs and effectiveness of respiratory distress syndrome based on the parent trial would be unlikely to show economic desirability.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of Antenatal Corticosteroid Therapy vs No Therapy in Women at Risk of Late Preterm Delivery

et al. 2019

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IMPORTANCE Administration of corticosteroids to women at high risk for delivery in the late preterm period (34–36 weeks’ gestation) improves short-term neonatal outcomes. The cost implications of this intervention are not known. OBJECTIVE To compare the cost-effectiveness of treatment with antenatal corticosteroids with no treatment for women at risk for late preterm delivery. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of the Antenatal Late Preterm Steroids trial, a multicenter randomized clinical trial of antenatal corticosteroids vs placebo in women at risk for late preterm delivery conducted from October 30,2010, to February 27,2015. took a third-party payer perspective. Maternal costs were based on Medicaid rates and included those of betamethasone, as well as the outpatient visits or inpatient stay required to administer betamethasone. All direct medical costs for newborn care were included. For infants admitted to the neonatal intensive care unit, comprehensive daily costs were stratified by the acuity of respiratory illness. For infants admitted to the regular newborn nursery, nationally representative cost estimates from the literature were used. Effectiveness was measured as the proportion of infants without the primary outcome of the study: a composite of treatment in the first 72 hours of continuous positive airway pressure or high-flow nasal cannula for 2 hours or more, supplemental oxygen with a fraction of inspired oxygen of 30% or more for 4 hours or more, and extracorporeal membrane oxygenation or mechanical ventilation. This secondary analysis was initially started in June 2016 and revision of the analysis began in May 2017. EXPOSURES Bethamethasone treatment. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio. RESULTS Costs were determined for 1426 mother-infant pairs in the betamethasone group (mean [SD] maternal age, 28.6 [6.3] years; 827 [58.0%] white) and 1395 mother-infant pairs in the placebo group (mean [SD] maternal age, 27.9 [6.2] years; 794 [56.9%] white). Treatment with betamethasone was associated with a total mean (SD) woman-infant-pair cost of $4681 ($5798), which was significantly less than the mean (SD) amount of $5379 ($8422) for women and infants in the placebo group (difference, $698; 95% Cl, $186-$1257; P = .02). The Antenatal Late Preterm Steroids trial determined that betamethasone use is effective: respiratory morbidity deceased by 2.9% (95% Cl, −0.5% to −5.4%). Thus, the cost-effectiveness ratio was −23 986. Inspection of the bootstrap replications confirmed that treatment was the dominant strategy in 5000 samples (98.8%). Sensitivity analyses showed that these results held under most assumptions. CONCLUSIONS AND RELEVANCE The findings suggest that antenatal betamethasone treatment is associated with a statistically significant decrease in health care costs and with improved outcomes; thus, this treatment may be an economically desirable strategy.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of Antenatal Corticosteroid Therapy vs No Therapy in Women at Risk of Late Preterm Delivery

et al. 2019

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“… Decision tree model 2011 Cost per QALY Single payer Lifetime effects High (21/23) Gyamfi-Bannerman 2019 34 USA Multi-centre trial in tertiary hospital settings ACS (betamethasone) 34 weeks 0 days to 36 weeks 6 days To assess whether betamethasone compared with standard of care (without betamethasone) was cost-effective. Cost-effectiveness analysis based on a randomized trial 2015 Cost per respiratory morbidity a Third party funder First 72 hours of neonatal period High (20/22) Rosenbloom 2020 32 USA Multi-centre trial in tertiary hospital settings ACS (betamethasone) 34 weeks 0 days to 36 weeks 6 days Compare betamethasone administration versus no betamethasone administration in patients at risk of delivery in the late-preterm period. Cost-effectiveness analysis based on a randomized clinical trial 2017 Cost per QALY Health sector 7.5 days (median duration of neonatal admission in the trial) High (20.5/22) Antenatal corticosteroids in preterm birth (broad or unspecified gestation) Johnson 1981 35 USA Tertiary hospital ACS (betamethasone) 26-35 weeks Determine whether prenatal glucocorticoid administration decreased the cost of newborn intensive care as well as mortality in infants born prematurely.…”

Section: Resultsmentioning

confidence: 99%

“…Included studies were published between 1981 and 2019, and were conducted in high-income (31 studies), upper-middle income (3 studies), and low-income (1 study) countries. Five of the studies on ACS related to administration prior to 34 weeks’ gestation, 26 , 27 , 28 , 29 , 30 , 31 three were on its use in the late preterm period (34 to <37 weeks’ gestation), 32 , 33 , 34 one studied both categories, 35 and two did not specify ( Table 1 ). 36 , 37 Eight of the studies on tocolytics for managing preterm labour examined the use of tocolytics for facilitating ACS administration, 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 and twelve studies related to tocolytic use for acute and maintenance tocolysis without explicit consideration of ACS ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“… ACS (not specified) partial course in 3 population subgroups Comparator: no treatment 34 weeks: US$131,233·39 per QALY 35 weeks: US$133,117·42 per QALY 36 weeks: US$133,654·76 per QALY Not cost effective at threshold of US$100,000/QALY Gyamfi-Bannerman 2019 34 Betamethasone Comparator: no treatment US$23,986 cost saving per case of respiratory morbidity averted Dominant Antenatal betamethasone treatment associated with a statistically significant decrease in health care costs and with improved outcomes; thus, this treatment may be an economically desirable strategy. Rosenbloom 2020 32 Betamethasone Comparator: no treatment US$88m cost increase (US$1,780m vs US$1,692m) and decrease of 11 QALYs (5,405 vs 5,416) per 270,000 live births Dominated by withholding treatment Withholding betamethasone dominated betamethasone administration and was cost-saving, i.e. less costly and more effective.…”

Section: Resultsmentioning

confidence: 99%

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Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: A systematic review

et al. 2022

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“…94 The cost-effectiveness of the administration of betamethasone based in individual trials is controversial, and it should be based in the best estimation of effectiveness. 95,96 Mainly LMICs still have significant challenges to provide safe and effective antenatal corticosteroid use, including ensuring accurate gestational age determination, establishing clear treatment guidelines, strengthening provider capacity, incorporating corticosteroid in national essential medicines lists, and monitoring use and outcomes. 97…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone vs. betamethasone for preterm birth: a systematic review and network meta-analysis

Ciapponi

Klein

Colaci

et al. 2020

Preprint

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Objective To compare the effectiveness and safety of dexamethasone versus betamethasone for preterm birth (registered in PROSPERO CRD42017078006). Search strategy We searched in MEDLINE, EMBASE, Cochrane Library, LILACS, Clinical Trials.gov, International Clinical Trials Registry Platform, reference lists and contacted field experts. Selection criteria, data collection and analysis Randomized controlled trials comparing any corticosteroids against each other or against placebo. Three researchers independently selected, extracted data and assessed the risk of bias of the included studies by using EROS and COVIDENCE software. We performed a pairwise meta-analysis and Bayesian network meta-analysis. Main results We included 45 trials (11227 women, 11878 infants). There was no important difference between corticosteroids in neonatal death (odds ratio[OR] 1.05; 95% confidence interval 0.62-1.84; moderate-certainty evidence[CE]), neurodevelopmental disability (OR 1.03; 0.80-1.33; moderate-CE), intraventricular haemorrhage (OR 1.04; 0.56-1.78); low-CE) and birthweight (+5.29 gr;-49.79 to 58.97; high-CE). Compared with betamethasone, dexamethasone may reduce chorioamnionitis (OR 0.70; 0.45-1.06; moderate-CE), foetal death (OR 0.81; 0.24-2.41; low-CE) while may increase puerperal sepsis (OR 2.04; 0.72-6.06; low-CE) and respiratory distress syndrome (OR 1.34; 0.96-2.11; moderate-CE), however, the confidence interval indicates both beneficial and detrimental effects. Conclusions We found no important difference on neonatal death, neurodevelopmental disability, intraventricular haemorrhage and birthweight between corticosteroids. Compared with betamethasone, dexamethasone may reduce chorioamnionitis and foetal death, but may increase endometritis/puerperal sepsis and respiratory distress syndrome. Further research is warranted to improve the certainty of evidence.

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Antenatal corticosteroid administration in late-preterm gestations: a cost-effectiveness analysis

Cited by 4 publications

References 32 publications

Cost-effectiveness of Antenatal Corticosteroid Therapy vs No Therapy in Women at Risk of Late Preterm Delivery

Cost-effectiveness of Antenatal Corticosteroid Therapy vs No Therapy in Women at Risk of Late Preterm Delivery

Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: A systematic review

Dexamethasone vs. betamethasone for preterm birth: a systematic review and network meta-analysis

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