OBJECTIVES

In neonatal intensive care units (NICUs) in Qatar, while most clinicians follow the recommended single-dose approach of surfactant administration in the management of meconium aspiration syndrome (MAS), it seems that several choose instead to administer multiple subsequent doses of the surfactant, assuming an enhanced efficacy. This study was to compare the different surfactant dosing regimens in MAS management in NICU settings, from both clinical and economic aspects.

METHODS

This is a retrospective cost-effectiveness analysis of critically ill neonates with MAS receiving single-dose surfactant versus multiple-doses at NICUs in Hamad Medical Corporation (HMC), Qatar. Clinical data of neonates were extracted from patient medical records of HMC from 2014 to 2018. A decision-analytic model from the hospital's perspective was constructed to follow possible consequences of the use of either option. Primary endpoints were (i) treatment success defined as the improvement in oxygenation over baseline 24 h after treatment, evaluated by the reduction of oxygen index (OI) to less than 10, and (ii) the overall direct medical cost of therapy.

RESULTS

Based on a population size of 60 patients, multiple-doses achieved a success of 53.3% versus a 56.7% with the single-dosing of surfactant (risk ratio = 1.0769; 95% CI, 0.5465 – 2.1222; P = 0.839). With a non-significant difference in effectiveness between the two approached, and a cost-saving of US$ 18904 associated with the single-dose approach of surfactant administration, the multiple-dose regimen is found to be dominated by the single-dose regimen of the surfactant. Sensitivity analysis concluded model insensitivity to input uncertainties, except in relation to NICU stay and cost of mechanical ventilation.

CONCLUSIONS

This is the first clinical and economics analysis among different surfactant regimens in MAS. The multiple dosing of surfactant increased the overall cost of therapy, without an significant increase in the effectiveness of the surfactant against MAS.