Presentation (CTI)

OBJECTIVES: Neonatal respiratory distress syndrome (NRDS) is a major cause of morbidity and mortality in preterm infants. This study aims to evaluate the cost-effectiveness of Poractant alfa (porcine-derived) and Calfactant (bovine-derived) in the management of NRDS.
METHODS: A multicenter retrospective comparative cost-effectiveness study was conducted at Mongi Slim University Hospital and the Maternity and Neonatology Center (MNC). Premature neonates (<37 weeks' gestational age) treated between January 2021 and December 2023 with either Poractant alfa or Calfactant were included. The primary effectiveness outcome was the duration of oxygen therapy. Secondary outcomes included retinopathy of prematurity (ROP) and intraventricular hemorrhage (IVH). Direct medical costs included surfactant acquisition, hospitalization, diagnostic investigations, and antibiotic therapy for complication management.
RESULTS: Fifty-two preterm neonates were included: 34 received Poractant alfa and 18 Calfactant. Baseline gestational age (31.6 vs 32.6 weeks) and birth weight (1691 vs 1755 g) were comparable. Poractant alfa showed a non-significant reduction in oxygen therapy duration (9.8 vs 12.6 days; p=0.356). However, it significantly reduced ROP (2.9% vs 16.7%; p=0.039) and IVH (23.5% vs 50.0%; p=0.026). Mean total cost was higher with Poractant alfa (€1,396 vs €1,231), mainly because of higher acquisition costs (€876 vs €575; p<0.001), partially offset by lower hospitalization costs. The incremental cost-effectiveness ratio was €1,409 per ROP case avoided and €734 per IVH case avoided.
CONCLUSIONS: Despite higher acquisition costs, Poractant alfa demonstrated superior clinical effectiveness by significantly reducing severe neurological and ophthalmological complications. These findings support its cost-effectiveness and provide evidence to guide surfactant selection and reimbursement decisions in resource-limited settings.