Antenatal corticosteroids: analytical decision model and economic analysis in a Brazilian cohort of preterm infants.

OBJECTIVE: To analyze the hospital costs and the effectiveness of antenatal corticosteroid (ACS) therapy in a cohort of Brazilian preterm infants.

METHODS: Infants with gestational age (GA) 26 to 32 weeks, born between 2006 and 2009 in a tertiary university hospital and who survived hospitalization were included. A decision tree was built according to GA (26-27, 28-29, 30-31 and 32 weeks), assuming that each patient exposed or not to ACS may or not develop one of the clinical outcomes included in the model. The cost of each outcome was calculated by microcosting. Sensitivity analysis tested the model stability and calculated outcomes and costs per 1000 patients.

RESULTS: The cost-effectiveness analysis indicated that ACS reduced USD 3413 in hospital costs per patient exposed to ACS. Its use decreased oxygen dependency at 36 weeks in 11%, advanced resuscitation in delivery room in 24%, severe peri-intraventricular hemorrhage in 12%, patent ductus arteriosus requiring surgery in 3.6% and retinopathy of prematurity in 0.3%, but increased the probability of late-onset sepsis in 2.5%. The sensitivity analysis indicated that ACS was dominant over no ACS therapy for most outcomes.

CONCLUSION: The results indicate that ACS therapy decreases costs and severe neonatal outcomes of preterm infants.