Resuscitation of neonates at 23 weeks' gestational age: A cost-effectiveness analysis

J. Colin Partridge, Kathryn R. Robertson, Elizabeth E. Rogers, Geri Ottaviano Landman, Allison J. Allen, Aaron Caughey

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: Resuscitation of infants at 23 weeks' gestation remains controversial; clinical practices vary. We sought to investigate the cost effectiveness of resuscitation of infants born 23 0/7-23 6/7 weeks' gestation. Design: Decision-analytic modeling comparing universal and selective resuscitation to non-resuscitation for 5176 live births at 23 weeks in a theoretic U.S. cohort. Estimates of death (77%) and disability (64-86%) were taken from the literature. Maternal and combined maternal-neonatal utilities were applied to discounted life expectancy to generate QALYs. Incremental cost-effectiveness ratios were calculated, discounting costs and QALYs. Main outcomes included number of survivors, their outcome status and incremental cost-effectiveness ratios for the three strategies. A cost-effectiveness threshold of $100000/QALY was utilized. Results: Universal resuscitation would save 1059 infants: 138 severely disabled, 413 moderately impaired and 508 without significant sequelae. Selective resuscitation would save 717 infants: 93 severely disabled, 279 moderately impaired and 343 without significant sequelae. For mothers, non-resuscitation is less expensive ($19.9 million) and more effective (127844 mQALYs) than universal resuscitation ($1.2 billion; 126574 mQALYs) or selective resuscitation ($845 million; 125966 mQALYs). For neonates, both universal and selective resuscitation were cost-effective, resulting in 22256 and 15134 nQALYS, respectively, versus 247 nQALYs for non-resuscitation. In sensitivity analyses, universal resuscitation was cost-effective from a maternal perspective only at utilities for neonatal death

Original languageEnglish (US)
Pages (from-to)121-130
Number of pages10
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume28
Issue number2
DOIs
StatePublished - Jan 1 2015

Fingerprint

Resuscitation
Gestational Age
Cost-Benefit Analysis
Newborn Infant
Quality-Adjusted Life Years
Mothers
Costs and Cost Analysis
Pregnancy
Decision Support Techniques
Live Birth
Life Expectancy
Survivors

Keywords

  • Cost-effectiveness
  • Death and dying
  • Decision-making
  • Ethics
  • Extreme prematurity
  • Health policy
  • Perinatal care
  • Resuscitation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

Resuscitation of neonates at 23 weeks' gestational age : A cost-effectiveness analysis. / Colin Partridge, J.; Robertson, Kathryn R.; Rogers, Elizabeth E.; Landman, Geri Ottaviano; Allen, Allison J.; Caughey, Aaron.

In: Journal of Maternal-Fetal and Neonatal Medicine, Vol. 28, No. 2, 01.01.2015, p. 121-130.

Research output: Contribution to journalArticle

Colin Partridge, J. ; Robertson, Kathryn R. ; Rogers, Elizabeth E. ; Landman, Geri Ottaviano ; Allen, Allison J. ; Caughey, Aaron. / Resuscitation of neonates at 23 weeks' gestational age : A cost-effectiveness analysis. In: Journal of Maternal-Fetal and Neonatal Medicine. 2015 ; Vol. 28, No. 2. pp. 121-130.
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