Antenatal Corticosteroids for Late-Preterm Infants: A Decision-Analytic and Economic Analysis

Bastek, Jamie A.; Langmuir, Holly; Kondapalli, Laxmi A.; Paré, Emmanuelle; Adamczak, Joanna E.; Srinivas, Sindhu K.

doi:10.5402/2012/491595

Cited by 10 publications

(15 citation statements)

References 23 publications

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“…Jacob et al 7 found late preterm birth was associated with higher health care costs compared with term birth and that these increased costs persisted into the first year of life. Before their introduction, Bastek et al 35 performed a decision and economic analysis to understand the potential cost implications of antenatal corticosteroid treatments for late preterm infants. They found that a full course of corticosteroids at 34, 35, or 36 weeks was associated with reduced cost and morbidity of late preterm birth.…”

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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“…However, the prior study was limited in that there is no evidence that betamethasone-administration changes childhood outcomes in the long-term [14]. In particular, antenatal corticosteroid exposure has not been shown to reduce the incidence of chronic lung disease, which was one of the main outcomes of the previous cost-effectiveness analysis [13,14]. Although late-prematurity is a risk factor for later pulmonary disease including asthma, wheeze, and chronic obstructive pulmonary disease, this risk appears to be independent of neonatal respiratory outcomes other than bronchopulmonary dysplasia and has not been shown to be affected by antenatal steroid administration [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…There has been only one published paper on the cost-effectiveness analysis of late-preterm betamethasone, which found betamethasone administration to be cost-effective in the longterm [13]. However, the prior study was limited in that there is no evidence that betamethasone-administration changes childhood outcomes in the long-term [14].…”

Section: Discussionmentioning

confidence: 99%

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

Rosenbloom

Lewkowitz

Sondgeroth

et al. 2018

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective-To evaluate whether administration of antenatal late-preterm betamethasone is costeffective in the immediate neonatal period. Study Design-Cost-effectiveness analysis of late-preterm betamethasone administration with a time horizon of 7.5 days was conducted using a health-system perspective. Data for neonatal outcomes, including respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), and hypoglycemia, were from the Antenatal Betamethasone for Women at Risk for Late Preterm Delivery trial. Cost data were derived from the Healthcare Cost and Utilization Project from the Agency for Healthcare Research and Quality, and utilities of neonatal outcomes were from the literature. Outcomes were total costs in 2017 United States dollars and quality-adjusted life-years (QALYs) for each individual infant as well as for a theoretical cohort of the 270,000 late-preterm infants born in 2015 in the United States.

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“…Corticosteroid administration could significantly decrease the risk of having intraventricular haemorrage from vasoconstrictor effect on fetal brain circulation. The recommended corticosteroid dosage was 12 mg betamethasone every 24 hours for 2 doses or 6 mg dexamethasone every 12 jam for 4 doses [5].…”

Section: Introductionmentioning

confidence: 99%

“…American Congress of Obstetricians and Gynaecologists (ACOG) published guidelines for corticosteroid administration is during 24 -34 6/7 weeks with threatened premature delivery [5]. During January 2000 until December 2004, incidence of respiratory distress in premature neonates that receive corticosteroid compared with the premature nenonates that did not receive corticosteroid is 24%:81.3% [6].…”

Section: Introductionmentioning

confidence: 99%

Differences of Asphyxia in Infants of 35 and 36 Weeks Pregnant Women with or without Antenatal Corticosteroids

Sabarudin¹,

Renardiansyah²,

Siddiq³

2015

OJOG

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Objective: To identify differences of Asphyxia in infants of 35-36 weeks with or without antenatal corticosteroid. Methods: Case control study was done on 35 and 36 weeks of pregnancy mother with threatened preterm labor who received and did not receive corticosteroids. Results: From 106 patients with threatened preterm labour between 35-36 gestational age, 53 patients received corticosteroid, and 53 did not receive corticosteroid. Incidence of asphyxia decreased significantly from patients received corticosteroid (34%:58.5%, P = 0.011). Incidence of decreased in patients received corticosteroid compared with patients did not receive corticosteroid (3.8%: 15.1%), but the difference was not significant (P = 0.093). Based on the length of stay at the hospital, babies receiving corticosteroid before delivery have shorter duration of stay (<3 days) with 94.3%: 84.9% (P = 0.224). Conclusion: There is a significant correlation of newborn asphyxia from 35-36 gestational weeks with or without corticosteroid treatment (58.5%:34%, P = 0.011).

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Antenatal Corticosteroids for Late-Preterm Infants: A Decision-Analytic and Economic Analysis

Cited by 10 publications

References 23 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

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

Differences of Asphyxia in Infants of 35 and 36 Weeks Pregnant Women with or without Antenatal Corticosteroids

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