Prevention of respiratory distress syndrome: cost-effectiveness for managing idiopathic preterm labor
OBJECTIVE: To determine the relative cost-effectiveness of three strategies for preventing respiratory distress syndrome (RDS) resulting from preterm labor and delivery: (1) empiric tocolysis with betamimetic agonists and treatment with corticosteroids (TREATALL), (2) amniocentesis and testing for fetal lung maturity, with treatment based on tests results (TESTALL), and (3) no treatment (TREATNONE). METHODS: We used a Markov decision analytic model to estimate the outcomes of each strategy. We took a health care system perspective and used a one-week time frame. We assumed there were no fetal or maternal indications for delivery, and that the patients were not diabetic. Probability variables were obtained from the literature and included the probability of delivery with preterm labor and of RDS by gestational age, the efficacy of betamimetics and corticosteroids, and the sensitivity and specificity of the test for fetal lung maturity. Cost variables were obtained from the Costs and Payments Department at Beth Israel Hospital and included the costs of amniocentesis, fetal lung maturity tests, betamimetics, corticosteroids, maternal hospital costs, costs associated with RDS and other neonatal costs. Sensitivity analysis was performed on all variables. RESULTS: The most cost-effective strategy varied with the probability of RDS. At probabilities ranging from 65% to 14%, corresponding to gestational ages from 28 to 34 wks, TREATALL was the most cost-effective strategy. TESTALL was most cost-effective from 14% to 1% (34 to 36 wks) and TREATNONE at probabilities less than 1% (>36 wks). TRF.ATALI. was more highly favored as the cost of RDS increased, while TESTAU.was more favored as the specificity of the test increased. CONCLUSION: Although testing for fetal lung maturity is useful in many clinical situations, the cost-effectiveness of such testing in the setting of idiopathic preterm labor appears to be limited to a narrow time frame.
