47 - Cost Effectiveness Analysis of Less Invasive Surfactant Administration versus Traditional Intubation with Endotracheal Tube in Neonates with Respiratory Distress Syndrome

Publication Number: 3044.47

Joleen Dako, Mercer University School of Medicine, Fayetteville, GA, United States

Background: Surfactant administration is often indicated in premature infants for the management of respiratory distress syndrome (RDS) with the goal of decreasing the risk of bronchopulmonary dysplasia (BPD). A new method of delivering surfactant through a thin catheter in a spontaneously breathing infant known as Less Invasive Surfactant Administration (LISA), has been adopted by some neonatal intensive care units (NICU) in lieu of traditional intubation with an endotracheal tube followed by extubation shortly after surfactant delivery known as the Intubate-Surfactant-Extubate (InSurE) method.

Objective: To complete a cost-effectiveness analysis comparing LISA with InSurE at a regional NICU

Design/Methods: We selected a large retrospective study comparing the two modes of surfactant delivery to estimate length of stay, ventilator days, duration of non-invasive respiratory support and complications such as intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP). We completed our calculations using two hypothetical groups of 100 infants with an average weight of 1000 grams who were treated with surfactant via LISA or InSurE. Information on billing of services was obtained from the cost center of the regional hospital. We estimated the costs of services offered by multiplying hospital charges in 2024 and an average cost-to-charge ratio (CCR) of 0.27. We calculated the Incremental cost effectiveness ratios comparing LISA and InSuRE and performed a univariate sensitivity analysis to evaluate the uncertainty based on our assumptions for the cost effectiveness analysis.

Results: We estimated a total cost of 6,856,704.95 United States dollars (USD) versus 7,384,084.65 USD for LISA and InSurE respectively. We calculated Cost Effectiveness Ratios (CER) of 120,293.07 USD/BPD case avoided and 164,090.77 USD/BPD case avoided for LISA and InSurE respectively. We found that LISA "dominates" (is superior to) InsurE consistently when considering BPD cases avoided. LISA costs less while avoiding more cases of BPD. The Incremental Cost Effectiveness Ratio (ICER) for LISA compared to InSurE was -43,948.31 USD/BPD case avoided. Univariate sensitivity analysis demonstrated that the most influential factors associated with cost were duration of non-invasive ventilation, total length of stay and duration of mechanical ventilation.

Conclusion(s): LISA is a cost-effective alternative to traditional intubation with an endotracheal tube for surfactant delivery in neonates with RDS in the NICU. The most influential factors for cost are duration of non-invasive ventilation, total length of stay and duration of mechanical ventilation

Table 1: Estimated Costs of Neonatal Intensive Care Unit (NICU) Stay by Surfactant Delivery Method for a Hypothetical Cohort of Infants


Table 2: Cost Effectiveness Analysis for Bronchopulmonary Cases Avoided using Less Invasive Surfactant Delivery and Intubate-Surfactant-Extubate Methods
a. Incremental Cost Effectiveness Ratio (ICER) = (Total Cost for LISA Group - Total Cost for InSurE Group)/Neonates without BPD in LISA Group - Neonates without BPD in InSurE Group)

Figure 1: Univariate Sensitivity Analysis of Cost per Bronchopulmonary Dysplasia Case Avoided