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Grand Rounds

In Women at Risk of Late Preterm Delivery, is Corticosteroid Therapy Still Cost-Effective?

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BACKGROUND AND PURPOSE:

  • Neonatal outcomes can be improved with corticosteroids in women at high risk for preterm birth in the late preterm period (34-36 weeks)
  • Gyamfi-Bannerman et al (JAMA Pediatrics 2019) sought to determine the cost-effectiveness of corticosteroid intervention in the late preterm period

METHODS:

  • A secondary analysis of the Antenatal Late Preterm Steroids (ALPS) trial
    • RCT in women at risk of late preterm delivery in two groups
      • Antenatal corticosteroids
      • Placebo
  • Maternal costs were based on Medicaid rates and included
    • Betamethasone
    • Outpatient visits or inpatient stay required for administration of betamethasone
    • Direct medical costs for newborn care
  • NICU: Daily costs were stratified by the acuity of respiratory illness
  • Regular newborn nursery: Representative cost estimates based on literature
  • Primary outcome: Composite of treatment in the first 72 hours
    • CPAP or high-flow nasal cannula for ≥2 hours
    • Supplemental oxygen with a fraction of inspired oxygen ≥30% for ≥4 hours
    • Extracorporeal membrane oxygenation or mechanical ventilation
  • Effectiveness measurement:
    • Mean incremental cost-effectiveness ratios (ICERs): $/proportion of infants without the primary outcome

RESULTS:

  • Betamethasone group
    • 1,426 mother-infant pairs | Average maternal age 28.6 years | 58.0% white
  • Placebo group
    • 1,395 mother-infant pairs | average maternal age 27.9 | 56.9% white

Dominant Strategy: Betamethasone

  • Total mean cost of treatment with betamethasone ($4,681) was less than placebo ($5,379)
    • Difference: $698 (95% CI, $186-$1257; P=0.02)
  • Betamethasone use is effective (ALPS trial data)
    • Respiratory morbidity decreased by 2.9% (95% CI, −0.5% to −5.4%)
  • Cost-effectiveness ICER ratio: -23,986

CONCLUSION:

  • Findings suggest that antenatal treatment with betamethasone in late preterm period is cost-effective for women at high-risk of delivery

Learn More – Primary Sources:

Cost-effectiveness of Antenatal Corticosteroid Therapy vs No Therapy in Women at Risk of Late Preterm Delivery

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Related ObG Topics:

Antenatal Corticosteroids – When to Administer?
Do Antenatal Corticosteroids Reduce Morbidity in Premature Neonates Prior to 24 weeks?
Does FGR Impact Neurocognitive Function in Childhood Following Repeat Antenatal Betamethasone Dosing?

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