COST EFFECTS OF SURFACTANT THERAPY FOR NEONATAL RESPIRATORY-DISTRESS SYNDROME

Objective: To examine the cost effects of a single dose (5 ml/kg) of a protein-free synthetic surfactant (Exosurf) as therapy for neonatal r espiratory distress syndrome, for both rescue and prophylactic therapy . Research design: Nonblinded, randomized clinical trials of both resc ue and prophylactic therapy. Regression analyses were used to control for the independent effects of sex, multiple birth, delivery method, b irth weight, and surfactant therapy. Setting: The prophylactic trial w as conducted at a university medical center only; the rescue trial als o included a tertiary community hospital. Patients: Prophylaxis was ad ministered immediately after birth to 36 infants (38 control subjects) with birth weights between 700 and 1350 gm. Rescue therapy was admini stered at 4 to 24 hours of age to 53 infants (51 control subjects) wit h established respiratory distress syndrome and birth weights greater- than-or-equal-to 650 gm (no upper limit). Infants in the prophylactic trial were not eligible for the rescue trial. Results: For the rescue trial, there was a $16,600 reduction in average hospital costs (p = 0. 18), which was larger than the cost of the surfactant ($450 to $900), yielding a probable net savings. For the prophylactic trial, hospital costs were larger for treated infants versus control subjects who weig hed less than about 1100 gm at birth and lower for treated infants ver sus control subjects who weighed more than 1100 gm at birth (p <0.05). For the prophylactic sample, the result was an average cost per life saved of $71,500. Conclusions: Single-dose rescue surfactant therapy i s probably a cost-effective therapy because it produced o lower mortal ity rate for the same (and probably lower) expenditure. Single-dose pr ophylactic therapy for smaller infants (less-than-or-equal-to 1350 gm) appeared to yield a reduction in mortality rate for a small additiona l cost. The use of multiple-dose therapy in infants who do not respond to initial therapy may alter the effects described above to either in crease or decrease the observed cost-effectiveness of surfactant thera py. Regardless, surfactant therapy will remain a cost-effective method of reducing mortality rates, relative to other commonly used health c are interventions.