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ISRN Obstetrics and Gynecology
Volume 2012 (2012), Article ID 491595, 7 pages
http://dx.doi.org/10.5402/2012/491595
Research Article

Antenatal Corticosteroids for Late-Preterm Infants: A Decision-Analytic and Economic Analysis

1Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, Center for Research on Reproduction and Women’s Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
2Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 585 Dulles Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
3Section of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, University of Colorado, Anschutz Medical Campus, Denver, Aurora, CO 80013, USA
4Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, BC, Canada V6T 1Z4
5Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Rady Children’s Hospital, San Diego, CA 92123, USA

Received 20 November 2012; Accepted 11 December 2012

Academic Editors: I. Diez-Itza and C. Iavazzo

Copyright © 2012 Jamie A. Bastek et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. Antenatal corticosteroids (ACS) are not routinely administered to patients at risk for delivery between 34 and 36 6/7 weeks. Our objective was to determine whether ACS are cost-effective for late-preterm infants at risk for imminent preterm delivery. We hypothesized that the preferred strategy <36 weeks would include ACS while the preferred strategy ≥36 weeks would not. Methods. We performed decision-analytic and cost-effectiveness analyses to determine whether ACS was cost-effective at 34, 35, and 36 weeks. We conducted a literature review to determine probability, utility, and cost estimates absent of patient-level data. Base-case cost-effectiveness analysis, univariable sensitivity analysis, and Monte Carlo simulation were performed. A threshold of $100,000/QALY was considered cost-effective. Results. The incremental cost-effectiveness ratio favored the administration of a full course of ACS at 34, 35, and 36 weeks ($62,888.25/QALY, $64,425.67/QALY, and $64,793.71/QALY, resp.). A partial course of ACS was not cost-effective. While ACS was the consistently dominant strategy for acute respiratory outcomes, all models were sensitive to changes in variables associated with chronic respiratory disease. Conclusions. Our findings suggest that the administration of ACS to patients at risk of imminent delivery 34-36 weeks could significantly reduce the cost and acute morbidity associated with late-preterm birth.