Journal article
Resuscitation of neonates at 23 weeks' gestational age: a cost-effectiveness analysis
The journal of maternal-fetal & neonatal medicine, Vol.28(2), pp.121-130
01/01/2015
DOI: 10.3109/14767058.2014.909803
PMID: 24684658
Abstract
Objective: Resuscitation of infants at 23 weeks' gestation remains controversial; clinical practices vary. We sought to investigate the cost effectiveness of resuscitation of infants born 23 0/7-23 6/7 weeks' gestation.
Design: Decision-analytic modeling comparing universal and selective resuscitation to non-resuscitation for 5176 live births at 23 weeks in a theoretic U.S. cohort. Estimates of death (77%) and disability (64-86%) were taken from the literature. Maternal and combined maternal-neonatal utilities were applied to discounted life expectancy to generate QALYs. Incremental cost-effectiveness ratios were calculated, discounting costs and QALYs. Main outcomes included number of survivors, their outcome status and incremental cost-effectiveness ratios for the three strategies. A cost-effectiveness threshold of $100 000/QALY was utilized.
Results: Universal resuscitation would save 1059 infants: 138 severely disabled, 413 moderately impaired and 508 without significant sequelae. Selective resuscitation would save 717 infants: 93 severely disabled, 279 moderately impaired and 343 without significant sequelae. For mothers, non-resuscitation is less expensive ($19.9 million) and more effective (127 844 mQALYs) than universal resuscitation ($1.2 billion; 126 574 mQALYs) or selective resuscitation ($845 million; 125 966 mQALYs). For neonates, both universal and selective resuscitation were cost-effective, resulting in 22 256 and 15 134 nQALYS, respectively, versus 247 nQALYs for non-resuscitation. In sensitivity analyses, universal resuscitation was cost-effective from a maternal perspective only at utilities for neonatal death <0.42. When analyzed from a maternal-neonatal perspective, universal resuscitation was cost-effective when the probability of neonatal death was <0.95.
Conclusions: Over wide ranges of probabilities for survival and disability, universal and selective resuscitation strategies were not cost-effective from a maternal perspective. Both strategies were cost-effective from a maternal-neonatal perspective. This study offers a metric for counseling and decision-making for extreme prematurity. Our results could support a more permissive response to parental requests for aggressive intervention at 23 weeks' gestation.
Details
- Title: Subtitle
- Resuscitation of neonates at 23 weeks' gestational age: a cost-effectiveness analysis
- Creators
- J. Colin Partridge - University of California, San FranciscoKathryn R. Robertson - University of California, San FranciscoElizabeth E. Rogers - University of California, San FranciscoGeri Ottaviano Landman - Boston Children's HospitalAllison J. Allen - Oregon Health & Science UniversityAaron B. Caughey - Oregon Health & Science University
- Resource Type
- Journal article
- Publication Details
- The journal of maternal-fetal & neonatal medicine, Vol.28(2), pp.121-130
- DOI
- 10.3109/14767058.2014.909803
- PMID
- 24684658
- NLM abbreviation
- J Matern Fetal Neonatal Med
- ISSN
- 1476-7058
- eISSN
- 1476-4954
- Publisher
- Taylor & Francis
- Number of pages
- 10
- Grant note
- Haile T. Debas Academy of Medical Educators Academy Chair in Pediatric Education
- Language
- English
- Date published
- 01/01/2015
- Academic Unit
- Obstetrics and Gynecology
- Record Identifier
- 9984848419802771
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