Pharmacy Department, Hamad Medical Corporation, Doha, Qatar.
Neonatal Intensive Care Unit Department, Hamad Medical Corporation, Doha, Qatar.
Clin Ther. 2019 Apr;41(4):714-727.e8. doi: 10.1016/j.clinthera.2019.02.009. Epub 2019 Mar 4.
Morphine and fentanyl opioids are common analgesic agents for consideration in the neonatal intensive care unit (NICU) for neonates with respiratory distress syndrome (RDS) and undergoing mechanical ventilation (MV). The aim of this study was to evaluate the clinical and economic impact of morphine versus fentanyl in neonates with RDS undergoing MV.
Retrospective cost-effectiveness analysis of critically ill neonates with RDS receiving standard doses of morphine versus fentanyl at Women's Wellness and Research Center, Qatar. Clinical data of neonates were extracted from medical records of patients from 2014 to 2016. A decision analytic model based on the hospital's perspective was constructed to follow possible consequences of the initial dosing of analgesia, before potential titration. Primary end points were successful pain relief rate based on the Premature Infant Pain Profile scale and overall direct medical cost of therapy. Study population of 126 neonates was used to achieve results with 80% power and 0.05 significance. Sensitivity analysis was conducted to enhance robustness of conclusions against input uncertainties and to increase generalizability of results.
Morphine achieved a success of 68% versus 43% with fentanyl (risk ratio = 1.72; 95% CI, 1.16-2.56; P = 0.0075). Morphine was associated with a minimal incremental cost-effectiveness ratio of USD 135 per additional case of successful pain relief over fentanyl. Higher morphine cost was reported in 2% of cases. Sensitivity analysis found model insensitivity to input uncertainties except NICU stay and cost of MV.
This is the first cost-effectiveness evaluation of morphine versus fentanyl in the NICU. Morphine significantly improved the relieve of pain over fentanyl. It had 98% probability of dominance over fentanyl. Results in this study support the use of morphine over fentanyl as first-line monotherapy with MV in NICU settings.
吗啡和芬太尼类阿片类药物是新生儿重症监护病房（NICU）中治疗呼吸窘迫综合征（RDS）并接受机械通气（MV）的新生儿常用的镇痛药物。本研究旨在评估吗啡与芬太尼在接受 MV 的 RDS 新生儿中的临床和经济影响。
对卡塔尔妇女健康与研究中心接受标准剂量吗啡与芬太尼治疗的 RDS 危重新生儿进行回顾性成本效益分析。从 2014 年至 2016 年患者的病历中提取新生儿的临床数据。根据医院的角度构建基于决策分析模型，以追踪初始镇痛剂量的可能后果，在潜在滴定之前。主要终点是根据早产儿疼痛量表（Premature Infant Pain Profile scale）评估的疼痛缓解成功率和治疗的总直接医疗费用。使用 126 例新生儿的研究人群得出结果，置信度为 80%，显著性水平为 0.05。进行敏感性分析以增强结论对输入不确定性的稳健性，并提高结果的通用性。
吗啡的成功率为 68%，而芬太尼为 43%（风险比=1.72；95%置信区间，1.16-2.56；P=0.0075）。与芬太尼相比，吗啡每增加一例疼痛缓解成功的额外成本效益比为 135 美元。有 2%的病例报告吗啡费用较高。敏感性分析发现，除新生儿重症监护病房住院时间和 MV 成本外，模型对输入不确定性不敏感。
这是对 NICU 中吗啡与芬太尼的首次成本效益评估。吗啡显著提高了芬太尼的镇痛效果。它对芬太尼有 98%的优势概率。本研究的结果支持在 NICU 环境中使用吗啡作为 MV 的一线单药治疗，而不是芬太尼。
