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

Abstract

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.

Short term outcomes of preterm infants following antenatal corticosteroid treatment for childbearing women at 34 (0/7) to 36 (6/7) weeks: do the advantages outweigh the disadvantages?

“…A large randomized trial study concerning ACS treatment, involving 1427 ACS-treated and 1400 placebo-treated pregnant women who gave birth at 34 (0/7) to 36 (6/7) gestation, found use of ACS for pregnant women, could decrease the incidence of severe respiratory complications of preterm infants, but had no in uence on the use of mechanical ventilation for preterm infants and the incidence of neonatal sepsis. The above ndings are consistent with our research [8,10].…”

“…There are positive and negative views on ACS treatment for women at high risk of giving birth at 34 (0/7) to 36 (6/7) weeks. The positive view indicates that ACS treatment can decrease incidence of neonatal respiratory distress syndrome (NRDS) and neonatal hospitalization expenses in preterm infants between 34 (0/7) to 36 (6/7) weeks gestation [8][9][10]. The negative view indicates that this treatment does not reduce respiratory disease and wet lung in late preterm infants, but increases incidence of neonatal hypoglycemia and neonatal sepsis [11,12].…”

Perinatal Outcomes Associated with Latency in Late Preterm Premature Rupture of Membranes

“…Previous trials demonstrated an improvement in neonatal respiratory outcomes with betamethasone, followed by a significant reduction in RDS in late preterm infants exposed to antenatal steroids [ 18 ] and a decrease in health care costs [ 19 ]. However, these studies included all LPT births, regardless of various causes of preterm birth or PPROM.…”

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

“…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…”