This pharmacoeconomic analysis is based on data from a retrospective study, published in the Journal of Neonatal- Perinatal Medicine (Volume 4, Number 2, 2011). This previously-published study, based on data from Discovery Labs' two large phase 3 trials involving a total of 1546 patients, assessed the influence of reintubation on the risk of morbidity and mortality in preterm infants receiving surfactant therapy for the prevention of RDS, as well as the relative rates of reintubation between surfactant therapies. This article, the first published full description of the consequences of reintubation in a preterm neonate population, indicates that practitioners of neonatal medicine should choose therapeutic options that will optimize chances of successful extubation. This previously-published study concluded:
- Infants who were successfully extubated and did not require reintubation experienced a statistically significantly lower mortality rate across all treatment groups compared with infants who subsequently required reintubation (0.5 percent vs. 18 percent, respectively p<0.05).
- Infants who required reintubation had significantly higher rates of six major complications of prematurity, including BPD, necrotizing enterocolitis (a severe intestinal condition often requiring surgery and loss of bowel), sepsis, and intraventricular hemorrhage (bleeding into the brain).
- Nearly half of the infants requiring reintubation developed BPD, whereas only 15 percent of infants developed BPD if they were not reintubated ( p<0.05).
- Infants treated with SURFAXIN demonstrated a significantly lower reintubation rate compared with those infants treated with animal-derived surfactants Curosurf (33 percent vs. 47 percent respectively; p<0.05) and Survanta (35 percent vs. 43 percent respectively; p<0.05).
- Infants treated with SURFAXIN demonstrated a significantly higher combined outcome of survival without reintubation compared with those infants treated with animal-derived surfactants Curosurf (67 percent vs. 53 percent respectively; p<0.05) and Survanta (65 percent vs. 57 percent respectively; p<0.05).
- Initial extubation rates were similar among surfactant treatments in both trials (80 to 84 percent; p=ns)
- Decreased costs related to direct hospital expenses associated with the need for extended mechanical ventilation due to reintubation.
- Hospital cost savings of approximately $160,000 to $252,000 per 100 infants when compared with infants treated with Curosurf and Survanta.