Cost effectiveness of nifedipine compared with atosiban in the treatment of threatened preterm birth (APOSTEL IIItrial)

Abstract

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.

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

“… Period of 18 and 48 h, treating adverse effects for 72 h after administering tocolytics. Unable to assess a Nijman 2019 42 Netherlands, Belgium 19 facilities (seven secondary care and twelve tertiary care) Nifedipine vs Atosiban Women at 25 weeks 0 days to 33 weeks 0 days gestation in preterm labour Compare the costs and effects of nifedipine and atosiban in women with a threatened preterm birth. Cost-effectiveness analysis alongside randomised clinical trial 2013 Costs: a composite of adverse perinatal outcomes b Societal Neonatal period up to 6 weeks postpartum High (22.5/23) Wex 2009 44 Germany Multiple inpatient facilities Atosiban vs Fenoterol Women at 23 to 33 weeks’ gestation in preterm labour Compare economic implications of tocolysis using atosiban or betamimetics, considering treatment efficacy and safety, as well as cost consequences of treatment of associated adverse events.…”

“…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 ). 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 The aim of the studies considering the combination of ACS and tocolytics ( Table 3 ) was to examine different test-treatment strategies in the setting of preterm birth; and data relevant to ‘treatment only’ options were extracted.…”

“…Eight studies assessed cost-effectiveness for tocolytics when used to prolong pregnancy for at least 48 hours, of which seven explicitly stated this was to facilitate ACS administration 38 , 39 , 41 , 42 , 43 , 44 , 45 – the remaining study (abstract only) did not specify the reason ( Table 2 ). 40 All were conducted in high-income countries (Belgium, Canada, Czech Republic, Germany, Italy, Netherlands, Spain, and USA).…”

“…40 All were conducted in high-income countries (Belgium, Canada, Czech Republic, Germany, Italy, Netherlands, Spain, and USA). Three studies conducted a cost-effectiveness analysis alongside a randomised trial, 40 , 42 , 43 three studies constructed decision tree models using cost and outcome estimates from the literature, 38 , 39 , 41 and two studies by the same group conducted cost-minimisation analyses alongside a systematic review. 44 , 45 Analytical perspective varied between studies, including societal, 42 hospital, 38 , 43 health system, 41 health insurance company, 39 , 40 and multiple perspectives (hospital, payer and combined hospital and payer).…”

Effectiveness of Nifedipine Compared to Vaginal Progesterone in Treatment of Threatened Preterm Birth

“…Most current guidelines recommend a 48-hour course of prenatal corticosteroids for women with threatening preterm birth discovered before 34 weeks of pregnancy; tocolytic therapy is routinely provided for 48 hours in the majority of countries to allow administration of corticosteroids; however, there are exceptions [14].…”