OBJECTIVES: The aim of this study was to determine the cost-effectiveness of calfactant in comparison with beractant and poractant alfa in the treatment of premature infants with RDS in Iran to assist evidence-based decision making in the management of this disease.

METHODS: A decision tree model with two health states was developed and RDS infants (with average weight of 3.0118 kg (Median = 1.0975) by lognormal distribution) entered the model assuming that they were admitted to NICU since birth. Death OR of calfactant relative to beractant was entered the model as 0.86 (CI = 0.77-0.96), and death OR of calfactant relative to poractant as 1.20 (CI = 0.79-1.70), with poractant death rate equal to 3%. Resource use and costs, including those for medications and adverse events, were extracted from literature and tariff book, and all costs are presented in 2021 US dollars with a 5% discount rate for the model. Incremental cost-effectiveness ratio (ICER) and quality-adjusted life-years (QALYs) were computed for the agents, and sensitivity analyses were used to test the robustness of the results.

RESULTS: Average per patient treatment costs were US$13,398, US$15,730, and US$17,179 for each patient in calfactant, poractant, and beractant treatment, respectively. The total discounted lifelong QALY for calfactant, poractant, and beractant was 26.17, 26.55, and 25.79, respectively. Results showed that beractant was dominated and Poractant- with higher costs and effects- had an ICER of $6,146 over calfactant which is higher than the willingness-to-pay (WTP) threshold. The probabilistic analysis found calfactant cost-effective in 80% of simulations at the WTP of $2709 /QALY.

CONCLUSIONS: Compared to poractant and beractant, calfactant was cost-effective in RDS preterm infants in the Iranian healthcare system.