Health Economics and Outcomes of Surfactant Treatments for Respiratory Distress Syndrome Among Preterm Infants in US Level III/IV Neonatal Intensive Care Units

Abstract

Objective: To compare length of stay (LOS), costs, mechanical ventilation (MV), and mortality in preterm infants treated in the Neonatal Intensive Care Unit (NICU) with beractant (BE), calfactant (CA), and poractant alfa (PA) for Respiratory Distress Syndrome (RDS).

Methods: This study evaluated preterm infants born between 2010 and 2013 with RDS diagnosis, gestational age of 25 to 36 weeks, birthweight of ≥500 g, and age of ≤2 days on first surfactant administration. Multivariable regression was used to evaluate all NICU outcomes.

Results: Of 13,240 infants meeting the study criteria, 4136 (31.2%) received BE, 2502 (18.9%) received CA, and 6602 (49.9%) received PA. Adjusted analyses estimated similar mean LOS (BE 26.7 days, CA 27.8 days, and PA 26.2 days) and hospital costs (BE: $50,929; CA: $50,785; and PA: $50,212). Compared to PA, BE and CA were associated with greater odds of MV use on day 3 (OR = 1.56 and 1.60, respectively) and day 7 (OR = 1.39 and 1.28, respectively; all p < 0.05). Adjusted NICU mortality was significantly higher only with CA vs PA (OR = 1.51; p = 0.015).

Conclusion: Adjusted NICU LOS and costs were similar among BE, CA, and PA. Infants receiving PA were less likely to be on MV at 3 and 7 days, and PA treatment was associated with lower odds of NICU mortality when compared to CA.

Keywords: beractant; calfactant; costs; length of stay; mechanical ventilation; mortality; poractant alfa; respiratory distress syndrome; surfactant.

Figure 1.

Attrition diagram. Left panel shows attrition of the total newborn population from January 1, 2010, through December 31, 2013, receiving surfactant within 2 days of birth, treated in a level III or IV NICU, and diagnosed with RDS. Right panel further shows the attrition of these newborns receiving only one surfactant and meeting inclusion criteria for gestational age, birthweight, and born without serious congenital abnormalities and receiving surfactant during the index NICU stay. FDA-approved dosages (based on birthweight): beractant 100 mg/kg (initial and repeat doses); calfactant 105 mg/kg (initial and repeat doses); poractant alfa 200 mg/kg (initial dose), 100 mg/kg (repeat dose).

Figure 2.

Distribution of gestational age (A) and birthweight (B) intervals plotted against percent of preterm infants for the overall study population.

Figure 3.

Adjusted clinical outcomes. Forest plot depicts the odds ratio with 95% CI for mechanical ventilation at days 3 and 7 and for mortality. For comparisons that are statistically significant (p < 0.05), an OR of <1.0 favors the first surfactant and an OR of >1.0 favors the second comparator.