Grand Rounds

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

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

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

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

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

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