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Atosiban versus betamimetics in the treatment of preterm labour in Germany: an economic evaluation.
BMC Pregnancy Childbirth. 2009 Jun 19; 9:23.BP

Abstract

BACKGROUND

The use of tocolytics is central in delaying birth; however, therapeutic options vary in effectiveness and adverse events profiles, which in turn could have consequences for medical resource use and cost of treatment. Betamimetics are commonly used tocolytic agents, but their mechanism of action affects multiple organ systems leading to numerous adverse events. The availability of an oxytocin receptor antagonist, specific for prevention of preterm labour, offers a treatment option that merits further evaluation. We aimed to compare economic implications of tocolysis using atosiban and betamimetics, considering treatment efficacy and safety, as well as cost consequences of treatment of associated adverse events.

METHODS

A systematic literature review identified six randomised clinical trials, three of them double-blinded, comparing atosiban with betamimetics, in which tocolysis was initiated within 48 hours of admission. Cost of drug treatment was calculated based on trial protocols and German hospital drug purchase costs. G-DRG Grouper was used to obtain cost per case. The drug regimen was concordant with the German guidelines for the management of preterm labour, with two alternative modalities of fenoterol analysed: continuous or bolus administrations.

RESULTS

According to the results of the meta-analysis of the three double-blinded, placebo-controlled clinical trials, atosiban and betamimetics have similar efficacy (RR = 0.99, 95%CI:0.94-1.04, p = 0.772). Compared to betamimetics, use of atosiban was associated with a significantly lower frequency of adverse events for tachycardia, palpitation, vomiting, headache, hyperglycaemia, tremor, dyspnoea, chest pain, hypocalemia and foetal tachycardia. In our economic analysis, cost savings from using atosiban versus continuous, or bolus, fenoterol was 423euro per patient from the payer's perspective. From the hospital's perspective, savings from using atosiban versus continuous fenoterol ranged from 259euro for 18 hours of tocolysis to 105euro for 48 hours; the respective values for bolus fenoterol were 244euro and 55euro. In the probabilistic sensitivity analysis atosiban was cost saving versus both continuous and bolus fenoterol in 87%-100% of scenarios.

CONCLUSION

In a German setting, atosiban is cost saving versus betamimetics in the treatment of preterm labour from the payer, hospital and combined perspectives. Cost savings stem from the superior safety profile of atosiban.

Authors+Show Affiliations

PharmArchitecture Limited, Quatro House, Surrey, UK. jaro.wex@pharmarchitecture.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

19538754

Citation

Wex, Jaro, et al. "Atosiban Versus Betamimetics in the Treatment of Preterm Labour in Germany: an Economic Evaluation." BMC Pregnancy and Childbirth, vol. 9, 2009, p. 23.
Wex J, Connolly M, Rath W. Atosiban versus betamimetics in the treatment of preterm labour in Germany: an economic evaluation. BMC Pregnancy Childbirth. 2009;9:23.
Wex, J., Connolly, M., & Rath, W. (2009). Atosiban versus betamimetics in the treatment of preterm labour in Germany: an economic evaluation. BMC Pregnancy and Childbirth, 9, 23. https://doi.org/10.1186/1471-2393-9-23
Wex J, Connolly M, Rath W. Atosiban Versus Betamimetics in the Treatment of Preterm Labour in Germany: an Economic Evaluation. BMC Pregnancy Childbirth. 2009 Jun 19;9:23. PubMed PMID: 19538754.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atosiban versus betamimetics in the treatment of preterm labour in Germany: an economic evaluation. AU - Wex,Jaro, AU - Connolly,Mark, AU - Rath,Werner, Y1 - 2009/06/19/ PY - 2008/10/31/received PY - 2009/06/19/accepted PY - 2009/6/23/entrez PY - 2009/6/23/pubmed PY - 2009/8/28/medline SP - 23 EP - 23 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 9 N2 - BACKGROUND: The use of tocolytics is central in delaying birth; however, therapeutic options vary in effectiveness and adverse events profiles, which in turn could have consequences for medical resource use and cost of treatment. Betamimetics are commonly used tocolytic agents, but their mechanism of action affects multiple organ systems leading to numerous adverse events. The availability of an oxytocin receptor antagonist, specific for prevention of preterm labour, offers a treatment option that merits further evaluation. We aimed to compare economic implications of tocolysis using atosiban and betamimetics, considering treatment efficacy and safety, as well as cost consequences of treatment of associated adverse events. METHODS: A systematic literature review identified six randomised clinical trials, three of them double-blinded, comparing atosiban with betamimetics, in which tocolysis was initiated within 48 hours of admission. Cost of drug treatment was calculated based on trial protocols and German hospital drug purchase costs. G-DRG Grouper was used to obtain cost per case. The drug regimen was concordant with the German guidelines for the management of preterm labour, with two alternative modalities of fenoterol analysed: continuous or bolus administrations. RESULTS: According to the results of the meta-analysis of the three double-blinded, placebo-controlled clinical trials, atosiban and betamimetics have similar efficacy (RR = 0.99, 95%CI:0.94-1.04, p = 0.772). Compared to betamimetics, use of atosiban was associated with a significantly lower frequency of adverse events for tachycardia, palpitation, vomiting, headache, hyperglycaemia, tremor, dyspnoea, chest pain, hypocalemia and foetal tachycardia. In our economic analysis, cost savings from using atosiban versus continuous, or bolus, fenoterol was 423euro per patient from the payer's perspective. From the hospital's perspective, savings from using atosiban versus continuous fenoterol ranged from 259euro for 18 hours of tocolysis to 105euro for 48 hours; the respective values for bolus fenoterol were 244euro and 55euro. In the probabilistic sensitivity analysis atosiban was cost saving versus both continuous and bolus fenoterol in 87%-100% of scenarios. CONCLUSION: In a German setting, atosiban is cost saving versus betamimetics in the treatment of preterm labour from the payer, hospital and combined perspectives. Cost savings stem from the superior safety profile of atosiban. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/19538754/Atosiban_versus_betamimetics_in_the_treatment_of_preterm_labour_in_Germany:_an_economic_evaluation_ L2 - https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-9-23 DB - PRIME DP - Unbound Medicine ER -