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A pharmacoeconomic analysis of in-hospital costs resulting from reintubation in preterm infants treated with lucinactant, beractant, or poractant alfa.
MedLine Citation:
PMID:  23258964     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Reintubation and subsequent mechanical ventilation (MV) in preterm infants after surfactant replacement therapy are associated with excess morbidity and mortality and likely increase in-hospital costs. Specific surfactant therapy selection for prevention of respiratory distress syndrome (RDS) in preterm infants receiving conventional MV may impact not only clinical outcomes but also pharmacoeconomic outcomes.
METHODS: We conducted a pharmacoeconomic analysis of the impact of surfactant selection and reintubation and subsequent MV of preterm infants on health care resource utilization. Rates of reintubation and duration of MV after reintubation were determined from 1546 preterm infants enrolled in two surfactant trials comparing lucinactant to beractant and poractant alfa. Hospital costs were obtained from a 2010 US database from 1564 preterm infants with RDS, with a direct cost of $2637 per day for MV in the neonatal intensive care unit. Cost of reintubation by study and treatment was estimated as the incidence of reintubation multiplied by days on MV therapy after reintubation multiplied by cost per day for direct MV costs, standardized per 100 surfactant-treated infants.
RESULTS: There were no differences between studies or treatment groups in the overall extubation rate. Average MV duration following reintubation was similar between groups in both trials; however, reintubation rates were significantly lower (p<0 05) for infants treated with lucinactant than for those receiving beractant or poractant alfa. The observed differences in reintubation rates resulted in a projected cost saving of $160,013 to $252,203 per 100 infants treated with lucinactant versus animal-derived surfactants.
CONCLUSIONS: In this analysis, higher reintubation rates following successful extubation in preterm infants receiving animal-derived surfactant preparations significantly increased estimated in-hospital costs, primarily due to excess costs associated with MV. This analysis suggests that surfactant selection may have a significant pharmacoeconomic impact on cost of patient care. Additional cost assessment of potential reduction in reintubation-associated morbidity is warranted.
Authors:
Carlos G Guardia; Fernando R Moya; Sunil Sinha; Phillip D Simmons; Robert Segal; Jay S Greenspan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG     Volume:  17     ISSN:  1551-6776     ISO Abbreviation:  J Pediatr Pharmacol Ther     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-12-21     Completed Date:  2012-12-24     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101089851     Medline TA:  J Pediatr Pharmacol Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  220-7     Citation Subset:  -    
Affiliation:
Centro de Investigación Perinatal, Universidad de Chile, Santiago, Chile ; Discovery Laboratories, Inc., Warrington, Pennsylvania.
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