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Cost-effectiveness of Antenatal Corticosteroid Therapy vs No Therapy in Women at Risk of Late Preterm Delivery: A Secondary Analysis of a Randomized Clinical Trial.
JAMA Pediatr. 2019 05 01; 173(5):462-468.JP

Abstract

Importance

Administration of corticosteroids to women at high risk for delivery in the late preterm period (34-36 weeks' gestation) improves short-term neonatal outcomes. The cost implications of this intervention are not known.

Objective

To compare the cost-effectiveness of treatment with antenatal corticosteroids with no treatment for women at risk for late preterm delivery.

Design, Setting, and Participants

This secondary analysis of the Antenatal Late Preterm Steroids trial, a multicenter randomized clinical trial of antenatal corticosteroids vs placebo in women at risk for late preterm delivery conducted from October 30, 2010, to February 27, 2015. took a third-party payer perspective. Maternal costs were based on Medicaid rates and included those of betamethasone, as well as the outpatient visits or inpatient stay required to administer betamethasone. All direct medical costs for newborn care were included. For infants admitted to the neonatal intensive care unit, comprehensive daily costs were stratified by the acuity of respiratory illness. For infants admitted to the regular newborn nursery, nationally representative cost estimates from the literature were used. Effectiveness was measured as the proportion of infants without the primary outcome of the study: a composite of treatment in the first 72 hours of continuous positive airway pressure or high-flow nasal cannula for 2 hours or more, supplemental oxygen with a fraction of inspired oxygen of 30% or more for 4 hours or more, and extracorporeal membrane oxygenation or mechanical ventilation. This secondary analysis was initially started in June 2016 and revision of the analysis began in May 2017.

Exposures

Betamethasone treatment.

Main Outcomes and Measures

Incremental cost-effectiveness ratio.

Results

Costs were determined for 1426 mother-infant pairs in the betamethasone group (mean [SD] maternal age, 28.6 [6.3] years; 827 [58.0%] white) and 1395 mother-infant pairs in the placebo group (mean [SD] maternal age, 27.9 [6.2] years; 794 [56.9%] white). Treatment with betamethasone was associated with a total mean (SD) woman-infant-pair cost of $4681 ($5798), which was significantly less than the mean (SD) amount of $5379 ($8422) for women and infants in the placebo group (difference, $698; 95% CI, $186-$1257; P = .02). The Antenatal Late Preterm Steroids trial determined that betamethasone use is effective: respiratory morbidity decreased by 2.9% (95% CI, -0.5% to -5.4%). Thus, the cost-effectiveness ratio was -$23 986 per case of respiratory morbidity averted. Inspection of the bootstrap replications confirmed that treatment was the dominant strategy in 5000 samples (98.8%). Sensitivity analyses showed that these results held under most assumptions.

Conclusions and Relevance

The findings suggest that antenatal betamethasone treatment is associated with a statistically significant decrease in health care costs and with improved outcomes; thus, this treatment may be an economically desirable strategy.

Authors+Show Affiliations

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University, New York, New York.Department of Neonatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.George Washington University Biostatistics Center, Washington, DC.Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.Department of Obstetrics and Gynecology, University of Texas Health Science Center at Children's Memorial Hermann Hospital, Houston.Department of Obstetrics and Gynecology, University of Alabama, Birmingham.Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia.Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston.Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island.Department of Obstetrics and Gynecology, Ohio State University, Columbus.Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City.Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill.MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora.Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.Department of Obstetrics and Gynecology, Stanford University, Stanford, California.Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas.Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania.Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland.Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30855640

Citation

Gyamfi-Bannerman, Cynthia, et al. "Cost-effectiveness of Antenatal Corticosteroid Therapy Vs No Therapy in Women at Risk of Late Preterm Delivery: a Secondary Analysis of a Randomized Clinical Trial." JAMA Pediatrics, vol. 173, no. 5, 2019, pp. 462-468.
Gyamfi-Bannerman C, Zupancic JAF, Sandoval G, et al. Cost-effectiveness of Antenatal Corticosteroid Therapy vs No Therapy in Women at Risk of Late Preterm Delivery: A Secondary Analysis of a Randomized Clinical Trial. JAMA Pediatr. 2019;173(5):462-468.
Gyamfi-Bannerman, C., Zupancic, J. A. F., Sandoval, G., Grobman, W. A., Blackwell, S. C., Tita, A. T. N., Reddy, U. M., Jain, L., Saade, G. R., Rouse, D. J., Iams, J. D., Clark, E. A. S., Thorp, J. M., Chien, E. K., Peaceman, A. M., Gibbs, R. S., Swamy, G. K., Norton, M. E., Casey, B. M., ... VanDorsten, J. P. (2019). Cost-effectiveness of Antenatal Corticosteroid Therapy vs No Therapy in Women at Risk of Late Preterm Delivery: A Secondary Analysis of a Randomized Clinical Trial. JAMA Pediatrics, 173(5), 462-468. https://doi.org/10.1001/jamapediatrics.2019.0032
Gyamfi-Bannerman C, et al. Cost-effectiveness of Antenatal Corticosteroid Therapy Vs No Therapy in Women at Risk of Late Preterm Delivery: a Secondary Analysis of a Randomized Clinical Trial. JAMA Pediatr. 2019 05 1;173(5):462-468. PubMed PMID: 30855640.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of Antenatal Corticosteroid Therapy vs No Therapy in Women at Risk of Late Preterm Delivery: A Secondary Analysis of a Randomized Clinical Trial. AU - Gyamfi-Bannerman,Cynthia, AU - Zupancic,John A F, AU - Sandoval,Grecio, AU - Grobman,William A, AU - Blackwell,Sean C, AU - Tita,Alan T N, AU - Reddy,Uma M, AU - Jain,Lucky, AU - Saade,George R, AU - Rouse,Dwight J, AU - Iams,Jay D, AU - Clark,Erin A S, AU - Thorp,John M,Jr AU - Chien,Edward K, AU - Peaceman,Alan M, AU - Gibbs,Ronald S, AU - Swamy,Geeta K, AU - Norton,Mary E, AU - Casey,Brian M, AU - Caritis,Steve N, AU - Tolosa,Jorge E, AU - Sorokin,Yoram, AU - VanDorsten,J Peter, AU - ,, PY - 2019/3/12/pubmed PY - 2020/2/25/medline PY - 2019/3/12/entrez SP - 462 EP - 468 JF - JAMA pediatrics JO - JAMA Pediatr VL - 173 IS - 5 N2 - Importance: Administration of corticosteroids to women at high risk for delivery in the late preterm period (34-36 weeks' gestation) improves short-term neonatal outcomes. The cost implications of this intervention are not known. Objective: To compare the cost-effectiveness of treatment with antenatal corticosteroids with no treatment for women at risk for late preterm delivery. Design, Setting, and Participants: This secondary analysis of the Antenatal Late Preterm Steroids trial, a multicenter randomized clinical trial of antenatal corticosteroids vs placebo in women at risk for late preterm delivery conducted from October 30, 2010, to February 27, 2015. took a third-party payer perspective. Maternal costs were based on Medicaid rates and included those of betamethasone, as well as the outpatient visits or inpatient stay required to administer betamethasone. All direct medical costs for newborn care were included. For infants admitted to the neonatal intensive care unit, comprehensive daily costs were stratified by the acuity of respiratory illness. For infants admitted to the regular newborn nursery, nationally representative cost estimates from the literature were used. Effectiveness was measured as the proportion of infants without the primary outcome of the study: a composite of treatment in the first 72 hours of continuous positive airway pressure or high-flow nasal cannula for 2 hours or more, supplemental oxygen with a fraction of inspired oxygen of 30% or more for 4 hours or more, and extracorporeal membrane oxygenation or mechanical ventilation. This secondary analysis was initially started in June 2016 and revision of the analysis began in May 2017. Exposures: Betamethasone treatment. Main Outcomes and Measures: Incremental cost-effectiveness ratio. Results: Costs were determined for 1426 mother-infant pairs in the betamethasone group (mean [SD] maternal age, 28.6 [6.3] years; 827 [58.0%] white) and 1395 mother-infant pairs in the placebo group (mean [SD] maternal age, 27.9 [6.2] years; 794 [56.9%] white). Treatment with betamethasone was associated with a total mean (SD) woman-infant-pair cost of $4681 ($5798), which was significantly less than the mean (SD) amount of $5379 ($8422) for women and infants in the placebo group (difference, $698; 95% CI, $186-$1257; P = .02). The Antenatal Late Preterm Steroids trial determined that betamethasone use is effective: respiratory morbidity decreased by 2.9% (95% CI, -0.5% to -5.4%). Thus, the cost-effectiveness ratio was -$23 986 per case of respiratory morbidity averted. Inspection of the bootstrap replications confirmed that treatment was the dominant strategy in 5000 samples (98.8%). Sensitivity analyses showed that these results held under most assumptions. Conclusions and Relevance: The findings suggest that antenatal betamethasone treatment is associated with a statistically significant decrease in health care costs and with improved outcomes; thus, this treatment may be an economically desirable strategy. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/30855640/Cost_effectiveness_of_Antenatal_Corticosteroid_Therapy_vs_No_Therapy_in_Women_at_Risk_of_Late_Preterm_Delivery:_A_Secondary_Analysis_of_a_Randomized_Clinical_Trial_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2019.0032 DB - PRIME DP - Unbound Medicine ER -