Theoretical changes in neonatal hospitalisation costs after the introduction of porcine-derived lung surfactant ('Curosurf').
The aims of this study were to determine the effects of porcine-derived lung surfactant (PLS; 'Curosurf') therapy on mortality, periods of care and hospitalisation costs in a model cohort of 1000 premature neonates. In this cohort, 55% of the neonates would develop respiratory distress syndrome (RDS) and this would result in a mortality rate of 35%. The mortality rate among infants without RDS is 19%. Five modes of surfactant therapy were studied: (i) late rescue; (ii) early treatment; (iii) prophylaxis; (iv) multiple-dose treatment; and (v) high multiple-dose treatment. At a 55% incidence of RDS, we found that late rescue and single-dose treatment of severely ill neonates resulted in between 4 and 51 extra survivors, and that multiple-dose treatments increased the number of extra survivors by between 17 and 101. Early treatment and prophylaxis were found to be the most effective strategies, resulting in between 38 and 111 extra survivors. These 2 modes of surfactant therapy were also more effective than the other types of intervention at other incidences of RDS. The introduction of PLS therapy increased the total hospitalisation costs of the cohort of 1000 neonates [71 million Netherlands guilders (NLG) if no patients received surfactant] by 0.8 to 16.0% because of increased survival. Improved survival increased the mean period of intensive care by 0.5 to 12.6% and of nonintensive care by 0.6 to 16.0%, thereby increasing the need for more beds. Costs for PLS ranged from 0.3 to 1.2% of the total hospital costs. The additional costs of PLS therapy per additional survivor, compared with the 'do nothing' option, ranged from NLG68 034 to NLG136 233, and were lowest with prophylaxis and highest with high multiple-dose treatment. Savings in costs per survivor (0.2 to 4.1%) and nonsurvivor (5.1 to 23.1%) were highest with prophylaxis and early treatment, which were found to be the most cost effective of the strategies studied.
Egberts
J
J
Department of Obstetrics and Gynecology, University of Leiden, The Netherlands.
D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007902:Length of Stay; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D011663:Pulmonary Surfactants / Q000191:economics* / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D013534:Survival; D016896:Treatment Outcome