Pharmacoeconomics of surfactant therapy

Surfactant administration is now included as a part of the standard treatment for premature infants with respiratory distress syndrome (RDS). Therefore, clinical institutions have to select a surfactant basing upon clinical and, moreover, pharmacoeconomic considerations.
When dealing with pharmacoeconomy, it is important to consider many other factors beyond the simple acquisition cost. For instance, surfactants most expected to decrease overall healthcare resource utilization are those that reduce days of mechanical ventilation: less time required for mechanical ventilation is correlated with fewer complications, thus avoiding additional resource utilization. Moreover, the length of hospital stay should be considered, as well as the number of doses required and amount of waste incurred.
Some cost-effectiveness analyses have compared surfactant therapies to traditional non-surfactant-based approaches in the treatment of RDS. Overall, in addition to the positive therapeutic outcomes, the costs associated with surfactant treatment were found to be significantly lower than the control group.
It is also important to compare directly the pharmacoeconomics of the various surfactants. One study compared colfosceril, a synthetic surfactant, with beractant; newborns treated with the former drug required additional doses as compared to beractant-treated newborns, with an important benefit in annual cost avoidance. Beractant was associated to better pharmacoeconomy advantages also when compared to other natural surfactant, such as calfactant, mainly because the higher quantity of waste associated with calfactant dosing.
Poroactant alfa was compared to calfactant in mechanically ventilated infants. Significant differences were revealed between the two drugs for mean dosage administration times, administration costs, and cost of wasted product. The primary driver of cost differences was found to be wasted product; in addition, the mean doses administered for calfactant were greater than for poractant alfa, with dosage administration times significantly lower for poractant alfa. Moreover, 58.9% of poractant alfa and only 4.3% of calfactant doses were administered in less than 5 minutes. The total administration cost per dose for poractant alfa was $2.21, while the cost for calfactant was $3.08. When compared to beractant, poroactant alfa determined a cost saving ranging from 20% to 53%, according to the model used for the analysis.
A recent analysis evaluated the pharmacoeconomy of continuous positive airway pressure (CPAP) and early extubation plus poroactant alfa with respect to mechanical ventilation. Results showed that newborns treated with CPAP required a significantly lower number of mechanical ventilation days, with fewer long-term complications.
In conclusion, many trials have demonstrated the economic benefits of surfactant therapy. Analyses revealed that the choice of medication could result in cost savings for the institution such as the 20% to 53% reduction in institutional costs for poractant alfa as compared to beractant therapy. Surfactant therapy can also promote shorter durations of invasive management (i.e., mechanical ventilation). The advantages, both clinical and economical, associated with CPAP plus surfactant with respect to mechanical ventilation are also a further confirmation of the need for pharmacoeconomic models to comparatively assess the effectiveness of new clinical strategies against current standards.

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