593 - Impact of minimally invasive surfactant therapy on initial hospitalisation cost in a randomised controlled trial (RCT) in preterm infants supported with continuous positive airway pressure (CPAP)

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 593
Publication Number: 593.223

Ingrid A. Cox, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; C.Omar O. Kamlin, Royal Women's Hospital, Brunswick, Victoria, Australia; Francesca Orsini, MCRI, Melbourne, Victoria, Australia; Antonio De Paoli, Royal Hobart Hospital, Hobart, Tasmania, Australia; Howard W. Clark, University College London, London, England, United Kingdom; Peter Davis, University of Melbourne, Melbourne, Victoria, Australia; Roger F. Soll, Robert Larner, M.D., College of Medicine at the University of Vermont, Hinesburg, VT, United States; Barbara de Graaff, Menzies Institute for Medical Research, Hobart, Tasmania, Australia; petr otahal, University of Tasmania, Hobart, Tasmania, Australia; Andrew Palmer, University of Tasmania, Hobart, Tasmania, Australia; Peter A. Dargaville, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

Presenting Author(s)

Ingrid A. Cox, MD Grad Cert (economics) MSc (Health economics) PhD

Postdoctoral Research Fellow
Menzies Institute for Medical Research, University of Tasmania
Hobart, Tasmania, Australia

Background:

Minimally invasive surfactant therapy (MIST) is an alternative to intubation and surfactant delivery in preterm infants with respiratory distress syndrome (RDS) managed with CPAP from the outset. To date, no study has examined the effect of applying MIST on the costs and resource consumption associated with the first hospitalisation.

Objective:

To compare the per capita costs of initial hospitalisation in infants receiving MIST or standard treatment (ST) using data from a multicentre blinded parallel group RCT (OPTIMIST-A trial, JAMA 2021, 326:2478).

Design/Methods:

Preterm infants 25-28 weeks’ gestation requiring CPAP and FiO2≥0.30 were randomised < 6 h to MIST (200 mg/kg poractant alfa delivered with a thin catheter) or ST (continuation of CPAP, intubation, and surfactant as necessary). For this analysis, site specific cost attributes were combined with patient-level data, including birth weight (BW), need for intubation, number of surfactant doses, as well as durations of intubation, CPAP, nasal high flow, and length of hospital stay. Given the variations in costs and annual inflation across sites, these were standardised to Australian tariffs. Generalised linear models (GLM) with gamma and log link functions were used to estimate per capita costs, incremental costs and cost ratios between MIST and ST groups, and to assess infant-associated factors that influence costs. All costs were converted to 2021 United States dollars (USD).

Results:

19 participating sites in 9 countries contributed data, including 417 infants with a median gestation 27 (interquartile range 26-28) weeks and birth weight 931g (standard deviation 216g). For infants alive at 36 weeks (MIST=185, ST=191, total=376), mean total per capita costs (95% confidence interval) were $78,858 ($70,828; $86,889) and $88,003 ($80,209; $95,797) for the MIST and ST groups respectively, with nursing and physician costs representing the highest cost categories (Table 1). Incremental costs and cost ratios favoured MIST for all cost categories, except for surfactant costs which favoured the ST group, and hotel costs which were not different between groups. A similar trend was observed for resource utilisation. Multivariable GLM regression analysis demonstrated a heightened cost ratio (ST/MIST) for infants < 27 weeks’ gestation and those with BW < 10^th centile.

Conclusion(s):

In preterm infants with RDS supported with CPAP, selective application of MIST in the first 6 hours was associated with a considerable reduction in costs of initial hospitalisation and resource consumption.