Antenatal Corticosteroids for Late-Preterm Infants: A Decision-Analytic and Economic Analysis. (27th December 2012)

• Record Type: Journal Article
• Authors: Bastek, Jamie A.; Langmuir, Holly; Kondapalli, Laxmi A.; Paré, Emmanuelle; Adamczak, Joanna E.; Srinivas, Sindhu K.
• Other Names: Diez-Itza I. Academic Editor.; Iavazzo C. Academic Editor.
• Is Part Of: ISRN obstetrics and gynecology. Volume 2012(2012)
• Publication Date: 2012-12-27
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; Pregnancy Complications; Genital Diseases, Female; Gynecology; Obstetrics; Electronic journals; Periodical; Periodicals; Fulltext; Internet Resources; Periodicals; 618.2
• DOI: 10.5402/2012/491595
• Languages: English
• ISSNs: 2090-4436

Abstract

Abstract : Objectives . Antenatal corticosteroids (ACS) are not routinely administered to patients at risk for delivery between 34 and 36 6/7 weeks. Our objective was to determine whether ACS are cost-effective for late-preterm infants at risk for imminent preterm delivery. We hypothesized that the preferred strategy <36 weeks would include ACS while the preferred strategy ≥36 weeks would not. Methods . We performed decision-analytic and cost-effectiveness analyses to determine whether ACS was cost-effective at 34, 35, and 36 weeks. We conducted a literature review to determine probability, utility, and cost estimates absent of patient-level data. Base-case cost-effectiveness analysis, univariable sensitivity analysis, and Monte Carlo simulation were performed. A threshold of $100, 000/QALY was considered cost-effective. Results . The incremental cost-effectiveness ratio favored the administration of a full course of ACS at 34, 35, and 36 weeks ($62, 888.25/QALY, $64, 425.67/QALY, and $64, 793.71/QALY, resp.). A partial course of ACS was not cost-effective. While ACS was the consistently dominant strategy for acute respiratory outcomes, all models were sensitive to changes in variables associated with chronic respiratory disease. Conclusions . Our findings suggest that the administration of ACS to patients at risk of imminent delivery 34-36 weeks could significantly reduce the cost and acute morbidity associated with late-preterm birth.