Magnesium sulphate for fetal neuroprotection: a cost-effectiveness analysis

Abstract

Background: The aim of this study was to assess the cost-effectiveness of administering magnesium sulphate to patients in whom preterm birth at < 32+0 weeks gestation is either imminent or threatened for the purpose of fetal neuroprotection.

Methods: Multiple decision tree models and probabilistic sensitivity analyses were used to compare the administration of magnesium sulphate with the alternative of no treatment. Two separate cost perspectives were utilized in this series of analyses: a health system and a societal perspective. In addition, two separate measures of effectiveness were utilized: cases of cerebral palsy (CP) averted and quality-adjusted life years (QALYs).

Results: From a health system and a societal perspective, respectively, a savings of $2,242 and $112,602 is obtained for each QALY gained and a savings of $30,942 and $1,554,198 is obtained for each case of CP averted when magnesium sulphate is administered to patients in whom preterm birth is imminent. From a health system perspective and a societal perspective, respectively, a cost of $2,083 is incurred and a savings of $108,277 is obtained for each QALY gained and a cost of $28,755 is incurred and a savings of $1,494,500 is obtained for each case of CP averted when magnesium sulphate is administered to patients in whom preterm birth is threatened.

Conclusions: Administration of magnesium sulphate to patients in whom preterm birth is imminent is a dominant (i.e. cost-effective) strategy, no matter what cost perspective or measure of effectiveness is used. Administration of magnesium sulphate to patients in whom preterm birth is threatened is a dominant strategy from a societal perspective and is very likely to be cost-effective from a health system perspective.

Figure 1

Decision tree for the imminent preterm birth models. The decision tree used to compare standard care (no treatment) with administration of magnesium sulphate to patients in whom preterm birth at < 32⁺⁰ weeks gestation is imminent.

Figure 2

Decision tree for the threatened preterm birth models. The decision tree used to compare standard care (no treatment) with administration of magnesium sulphate to patients in whom preterm birth at < 32⁺⁰ weeks gestation is threatened.

Figure 3

ICEPs for the imminent preterm birth models. The black ellipses represent 95% confidence intervals.

Figure 4

CEACs for the imminent preterm birth models. The blue line depicts the probability of magnesium sulphate being cost-effective across all willingness-to-pay values up to $100,000. The red line depicts the probability of the alternative (no treatment) being cost effective across all willingness-to-pay values up to $100,000.

Figure 5

ICEPs for the threatened preterm birth models. The black ellipses represent 95% confidence intervals.

Figure 6

CEACs for the threatened preterm birth models. The blue line depicts the probability of magnesium sulphate being cost-effective across all willingness-to-pay values up to $100,000. The red line depicts the probability of the alternative (no treatment) being cost effective across all willingness-to-pay values up to $100,000.