title: An open label comparison of calfactant and poractant alfa administration traits and impact on neonatal intensive care unit resources.
abstract: OBJECTIVE
  To compare calfactant (CA) and poractant alfa (PA) administration traits, short-term clinical responses, and resource use in the neonatal respiratory distress syndrome (RDS) setting.
  
  
  METHODS
  An open label series of 277 (213 PA and 64 CA) infants was evaluated for 445 administrations. Registered respiratory therapists collected patient, surfactant administration, and postadministration clinical data. Economic analysis involved labor costs of surfactant administration and usage, wastage, and product average wholesale price. Analysis utilized the Mann-Whitney rank sum test for differences in administration time and either the chi-square or Fisher's exact test for categorical variables.
  
  
  RESULTS
  PA had a statistically lower bedside administration time than CA (3.8 minutes vs. 5.3 minutes; P = .006) and a higher percentage of doses administered in less than five minutes (58.9% vs. 4.3%; P < .001). Doses administered per patient were similar (1.67 vs. 1.72). PA and CA were similar in time to recovery (81.4% vs. 74.3%), percent desaturation (24.8% vs. 26.7%), and bradycardia (3.8% vs. 8.5%). Reflux was significantly higher (13.2% vs. 3.5%; P < .001) with CA. Economic analyses found total administration costs per dose were $2.21 for PA and $3.08 for CA. Mean wastage costs were $141.21 for PA and $337.34 for CA (P < .001).
  
  
  CONCLUSIONS
  PA appeared to utilize fewer neonatal intensive care unit resources than CA due to reduced administration time and less wastage of drug product. Future studies should more closely evaluate time, resource, wastage, and post-administrative clinical effects to fully assess the impact of surfactant products in this setting.
authors.affiliation: Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, Pennsylvania;
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerdes
authors.forename: William
authors.initials: W
authors.lastname: Seiberlich
authors.forename: Emidio M
authors.initials: EM
authors.lastname: Sivieri
authors.forename: Wallace
authors.initials: W
authors.lastname: Marsh
authors.forename: Dwight L
authors.initials: DL
authors.lastname: Varner
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Turck
authors.forename: John M
authors.initials: JM
authors.lastname: York
keywords: calfactant; pharmacoeconomics; poractant alfa; respiratory distress syndrome; surfactant