Bastek Jamie A, Langmuir Holly, Kondapalli Laxmi A, Paré Emmanuelle, Adamczak Joanna E, Srinivas Sindhu K
Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA ; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 585 Dulles Building, 3400 Spruce Street, Philadelphia, PA 19104, USA.
ISRN Obstet Gynecol. 2012;2012:491595. doi: 10.5402/2012/491595. Epub 2012 Dec 27.
Objectives. Antenatal corticosteroids (ACS) are not routinely administered to patients at risk for delivery between 34 and 36 6/7 weeks. Our objective was to determine whether ACS are cost-effective for late-preterm infants at risk for imminent preterm delivery. We hypothesized that the preferred strategy <36 weeks would include ACS while the preferred strategy ≥36 weeks would not. Methods. We performed decision-analytic and cost-effectiveness analyses to determine whether ACS was cost-effective at 34, 35, and 36 weeks. We conducted a literature review to determine probability, utility, and cost estimates absent of patient-level data. Base-case cost-effectiveness analysis, univariable sensitivity analysis, and Monte Carlo simulation were performed. A threshold of $100,000/QALY was considered cost-effective. Results. The incremental cost-effectiveness ratio favored the administration of a full course of ACS at 34, 35, and 36 weeks ($62,888.25/QALY, $64,425.67/QALY, and $64,793.71/QALY, resp.). A partial course of ACS was not cost-effective. While ACS was the consistently dominant strategy for acute respiratory outcomes, all models were sensitive to changes in variables associated with chronic respiratory disease. Conclusions. Our findings suggest that the administration of ACS to patients at risk of imminent delivery 34-36 weeks could significantly reduce the cost and acute morbidity associated with late-preterm birth.
目的。对于有在34至36 6/7周之间分娩风险的患者，通常不常规给予产前糖皮质激素（ACS）。我们的目的是确定ACS对于有即将早产风险的晚期早产儿是否具有成本效益。我们假设孕周<36周时的首选策略将包括使用ACS，而孕周≥36周时的首选策略则不包括。方法。我们进行了决策分析和成本效益分析，以确定在34、35和36周时ACS是否具有成本效益。我们进行了文献综述，以确定在缺乏患者层面数据的情况下的概率、效用和成本估计。进行了基础病例成本效益分析、单变量敏感性分析和蒙特卡罗模拟。100,000美元/质量调整生命年的阈值被认为具有成本效益。结果。增量成本效益比支持在34、35和36周时给予一整个疗程的ACS（分别为62,888.25美元/质量调整生命年、64,425.67美元/质量调整生命年和64,793.71美元/质量调整生命年）。ACS的部分疗程不具有成本效益。虽然ACS对于急性呼吸结局始终是占主导地位的策略，但所有模型对与慢性呼吸道疾病相关变量的变化均敏感。结论。我们的研究结果表明，对有在34 - 36周即将分娩风险的患者给予ACS，可显著降低与晚期早产相关的成本和急性发病率。
