The cost and effectiveness of surfactant replacement therapy at Johannesburg Hospital, November 1991-December 1992.
OBJECTIVE
To assess the impact of surfactant replacement therapy (SRT) on the outcome of hyaline membrane disease (HMD) and to assess the cost implications of a policy of selective administration of artificial surfactant.


METHODS
The short-term outcome of 103 newborns ventilated for HMD (61 selected for SRT according to initial and/or ongoing oxygen requirements) was compared with that of a historical control group of 173 infants ventilated for HMD before the introduction of SRT.


METHODS
Mortality and morbidity of HMD including death, bronchopulmonary dysplasia, pneumothorax, pulmonary haemorrhage, patent ductus arteriosus and intraventricular haemorrhage.


RESULTS
There were significant demographic differences between the treatment and control groups (black patients 74% v. 28%, P < 0.0001; unbooked mothers 72% v. 15%, P < 0.0001) as well as evidence of more severe lung disease in the treatment group (pressor support 44% v. 27%, P < 0.005; and paralysis during ventilation 38% v. 25%, P < 0.005). Pneumothorax was reduced in the SRT group (7% v. 17%, P < 0.01). There were no significant differences between the two groups in the incidence of BPD or mortality. The use of SRT added to the total cost of treating a patient ventilated for HMD.


CONCLUSIONS
The selective use of SRT had the effect of converting severe disease into moderate disease rather than achieving maximal benefit in all cases of HMD through routine use of the product. A policy of restricting use may result in cost savings where resources are limited.
D017046:Cost Savings; D005260:Female; D017721:Hospital Costs; D006801:Humans; D006819:Hyaline Membrane Disease / Q000188:drug therapy* / Q000191:economics; D007231:Infant, Newborn; D008297:Male; D010102:Oxygen Inhalation Therapy; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D016896:Treatment Outcome
D011663:Pulmonary Surfactants