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Cost effectiveness of nifedipine compared with atosiban in the treatment of threatened preterm birth (APOSTEL III trial).
BJOG. 2019 Jun; 126(7):875-883.BJOG

Abstract

OBJECTIVE

To assess the cost-effectiveness of treatment with nifedipine compared with atosiban in women with threatened preterm birth.

DESIGN

An economic analysis alongside a randomised clinical trial (the APOSTEL III study).

SETTING

Obstetric departments of 12 tertiary hospitals and seven secondary hospitals in the Netherlands and Belgium.

POPULATION

Women with threatened preterm birth between 25 and 34 weeks of gestation, randomised for tocolysis with either nifedipine or atosiban.

METHODS

We performed an economic analysis from a societal perspective. We estimated costs from randomisation until discharge. Analyses for singleton and multiple pregnancies were performed separately. The robustness of our findings was evaluated in sensitivity analyses.

MAIN OUTCOME MEASURES

Mean costs and differences were calculated per woman treated with nifedipine or atosiban. Health outcomes were expressed as the prevalence of a composite of adverse perinatal outcomes.

RESULTS

Mean costs per patients were significantly lower in the nifedipine group [singleton pregnancies: €34,897 versus €43,376, mean difference (MD) -€8479 [95% confidence interval (CI) -€14,327 to -€2016)]; multiple pregnancies: €90,248 versus €102,292, MD -€12,044 (95% CI -€21,607 to € -1671). There was a non-significantly higher death rate in the nifedipine group. The difference in costs was mainly driven by a lower neonatal intensive care unit admission (NICU) rate in the nifedipine group.

CONCLUSION

Treatment with nifedipine in women with threatened preterm birth results in lower costs when compared with treatment with atosiban. However, the safety of nifedipine warrants further investigation.

TWEETABLE ABSTRACT

In women with threatened preterm birth, tocolysis using nifedipine results in lower costs when compared with atosiban.

Authors+Show Affiliations

Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands. Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands.Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium. Department of Physiology, Hasselt University, Diepenbeek, Belgium.Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands.Department of Obstetrics and Gynaecology, University Medical Centre Nijmegen, Nijmegen, the Netherlands.Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands.Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands.Department of Obstetrics and Gynecology, School of Medicine, Monash University, Melbourne, Vic., Australia.Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

30666783

Citation

Nijman, Taj, et al. "Cost Effectiveness of Nifedipine Compared With Atosiban in the Treatment of Threatened Preterm Birth (APOSTEL III Trial)." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 126, no. 7, 2019, pp. 875-883.
Nijman T, van Baaren GJ, van Vliet E, et al. Cost effectiveness of nifedipine compared with atosiban in the treatment of threatened preterm birth (APOSTEL III trial). BJOG. 2019;126(7):875-883.
Nijman, T., van Baaren, G. J., van Vliet, E., Kok, M., Gyselaers, W., Porath, M. M., Woiski, M., de Boer, M. A., Bloemenkamp, K., Sueters, M., Franx, A., Mol, B., & Oudijk, M. A. (2019). Cost effectiveness of nifedipine compared with atosiban in the treatment of threatened preterm birth (APOSTEL III trial). BJOG : an International Journal of Obstetrics and Gynaecology, 126(7), 875-883. https://doi.org/10.1111/1471-0528.15625
Nijman T, et al. Cost Effectiveness of Nifedipine Compared With Atosiban in the Treatment of Threatened Preterm Birth (APOSTEL III Trial). BJOG. 2019;126(7):875-883. PubMed PMID: 30666783.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost effectiveness of nifedipine compared with atosiban in the treatment of threatened preterm birth (APOSTEL III trial). AU - Nijman,Taj, AU - van Baaren,G J, AU - van Vliet,Eog, AU - Kok,M, AU - Gyselaers,W, AU - Porath,M M, AU - Woiski,M, AU - de Boer,M A, AU - Bloemenkamp,Kwm, AU - Sueters,M, AU - Franx,A, AU - Mol,Bwj, AU - Oudijk,M A, Y1 - 2019/03/27/ PY - 2019/01/10/accepted PY - 2019/1/23/pubmed PY - 2019/5/21/medline PY - 2019/1/23/entrez KW - Atosiban KW - cost-effectiveness KW - nifedipine KW - perinatal outcomes KW - preterm birth KW - tocolysis SP - 875 EP - 883 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 126 IS - 7 N2 - OBJECTIVE: To assess the cost-effectiveness of treatment with nifedipine compared with atosiban in women with threatened preterm birth. DESIGN: An economic analysis alongside a randomised clinical trial (the APOSTEL III study). SETTING: Obstetric departments of 12 tertiary hospitals and seven secondary hospitals in the Netherlands and Belgium. POPULATION: Women with threatened preterm birth between 25 and 34 weeks of gestation, randomised for tocolysis with either nifedipine or atosiban. METHODS: We performed an economic analysis from a societal perspective. We estimated costs from randomisation until discharge. Analyses for singleton and multiple pregnancies were performed separately. The robustness of our findings was evaluated in sensitivity analyses. MAIN OUTCOME MEASURES: Mean costs and differences were calculated per woman treated with nifedipine or atosiban. Health outcomes were expressed as the prevalence of a composite of adverse perinatal outcomes. RESULTS: Mean costs per patients were significantly lower in the nifedipine group [singleton pregnancies: €34,897 versus €43,376, mean difference (MD) -€8479 [95% confidence interval (CI) -€14,327 to -€2016)]; multiple pregnancies: €90,248 versus €102,292, MD -€12,044 (95% CI -€21,607 to € -1671). There was a non-significantly higher death rate in the nifedipine group. The difference in costs was mainly driven by a lower neonatal intensive care unit admission (NICU) rate in the nifedipine group. CONCLUSION: Treatment with nifedipine in women with threatened preterm birth results in lower costs when compared with treatment with atosiban. However, the safety of nifedipine warrants further investigation. TWEETABLE ABSTRACT: In women with threatened preterm birth, tocolysis using nifedipine results in lower costs when compared with atosiban. SN - 1471-0528 UR - https://www.unboundmedicine.com/medline/citation/30666783/Cost_effectiveness_of_nifedipine_compared_with_atosiban_in_the_treatment_of_threatened_preterm_birth__APOSTEL_III_trial__ L2 - https://doi.org/10.1111/1471-0528.15625 DB - PRIME DP - Unbound Medicine ER -