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- Title
Cost effectiveness of nifedipine compared with atosiban in the treatment of threatened preterm birth (APOSTEL III trial).
- Authors
Nijman, TAJ; Baaren, GJ; Vliet, EOG; Kok, M; Gyselaers, W; Porath, MM; Woiski, M; Boer, MA; Bloemenkamp, KWM; Sueters, M; Franx, A; Mol, BWJ; Oudijk, MA; van Baaren, G J; van Vliet, Eog; Porath, M M; de Boer, M A; Oudijk, M A
- Abstract
<bold>Objective: </bold>To assess the cost-effectiveness of treatment with nifedipine compared with atosiban in women with threatened preterm birth.<bold>Design: </bold>An economic analysis alongside a randomised clinical trial (the APOSTEL III study).<bold>Setting: </bold>Obstetric departments of 12 tertiary hospitals and seven secondary hospitals in the Netherlands and Belgium.<bold>Population: </bold>Women with threatened preterm birth between 25 and 34 weeks of gestation, randomised for tocolysis with either nifedipine or atosiban.<bold>Methods: </bold>We performed an economic analysis from a societal perspective. We estimated costs from randomisation until discharge. Analyses for singleton and multiple pregnancies were performed separately. The robustness of our findings was evaluated in sensitivity analyses.<bold>Main Outcome Measures: </bold>Mean costs and differences were calculated per woman treated with nifedipine or atosiban. Health outcomes were expressed as the prevalence of a composite of adverse perinatal outcomes.<bold>Results: </bold>Mean costs per patients were significantly lower in the nifedipine group [singleton pregnancies: €34,897 versus €43,376, mean difference (MD) -€8479 [95% confidence interval (CI) -€14,327 to -€2016)]; multiple pregnancies: €90,248 versus €102,292, MD -€12,044 (95% CI -€21,607 to € -1671). There was a non-significantly higher death rate in the nifedipine group. The difference in costs was mainly driven by a lower neonatal intensive care unit admission (NICU) rate in the nifedipine group.<bold>Conclusion: </bold>Treatment with nifedipine in women with threatened preterm birth results in lower costs when compared with treatment with atosiban. However, the safety of nifedipine warrants further investigation.<bold>Tweetable Abstract: </bold>In women with threatened preterm birth, tocolysis using nifedipine results in lower costs when compared with atosiban.
- Subjects
BELGIUM; NETHERLANDS; PREMATURE labor; COST effectiveness; NIFEDIPINE; THERAPEUTICS; MULTIPLE pregnancy; COMPARATIVE studies; PREMATURE infants; RESEARCH methodology; MEDICAL cooperation; PITUITARY hormones; PRENATAL care; RESEARCH; RESEARCH funding; EVALUATION research; RANDOMIZED controlled trials; TOCOLYTIC agents; PREVENTION
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2019, Vol 126, Issue 7, p875
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.15625