TY - JOUR
T1 - Cost effectiveness of nifedipine compared with atosiban in the treatment of threatened preterm birth (APOSTEL III trial)
AU - Nijman, Tobias A J
AU - van Baaren, Gert Jan
AU - van Vliet, Elvira O G
AU - Kok, Marjolein
AU - Gyselaers, Wilfried
AU - Porath, Martina M
AU - Woiski, Mallory
AU - de Boer, Marjon A
AU - Bloemenkamp, Kitty W M
AU - Sueters, Marieke
AU - Franx, Arie
AU - Mol, Ben Willem J
AU - Oudijk, Martijn A
N1 - Funding Information:
The Apostel III trial was funded by ZonMw, the Dutch Organization for Health Research and Development Healthcare Rational Medicine program, project number 836011005. No extra funding was obtained for the economic analysis. We would like to thank all research nurses, midwives, and administrative assistants of our consortium; and the residents, nurses, midwives, and gynaecologists of the participating centres for their help with recruitment and data collection.
Publisher Copyright:
© 2019 Royal College of Obstetricians and Gynaecologists
PY - 2019/6
Y1 - 2019/6
N2 - Objective: To assess the cost-effectiveness of treatment with nifedipine compared with atosiban in women with threatened preterm birth. Design: An economic analysis alongside a randomised clinical trial (the APOSTEL III study). Setting: Obstetric departments of 12 tertiary hospitals and seven secondary hospitals in the Netherlands and Belgium. Population: Women with threatened preterm birth between 25 and 34 weeks of gestation, randomised for tocolysis with either nifedipine or atosiban. Methods: 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. Main outcome measures: 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. Results: 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. Conclusion: 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. Tweetable abstract: In women with threatened preterm birth, tocolysis using nifedipine results in lower costs when compared with atosiban.
AB - Objective: To assess the cost-effectiveness of treatment with nifedipine compared with atosiban in women with threatened preterm birth. Design: An economic analysis alongside a randomised clinical trial (the APOSTEL III study). Setting: Obstetric departments of 12 tertiary hospitals and seven secondary hospitals in the Netherlands and Belgium. Population: Women with threatened preterm birth between 25 and 34 weeks of gestation, randomised for tocolysis with either nifedipine or atosiban. Methods: 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. Main outcome measures: 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. Results: 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. Conclusion: 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. Tweetable abstract: In women with threatened preterm birth, tocolysis using nifedipine results in lower costs when compared with atosiban.
KW - Atosiban
KW - cost-effectiveness
KW - nifedipine
KW - perinatal outcomes
KW - preterm birth
KW - tocolysis
KW - Pregnancy, Multiple
KW - Premature Birth/economics
KW - Humans
KW - Vasotocin/analogs & derivatives
KW - Prenatal Care/economics
KW - Pregnancy
KW - Tocolytic Agents/economics
KW - Nifedipine/economics
KW - Cost-Benefit Analysis
KW - Female
UR - http://www.scopus.com/inward/record.url?scp=85063586646&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.15625
DO - 10.1111/1471-0528.15625
M3 - Article
C2 - 30666783
SN - 1470-0328
VL - 126
SP - 875
EP - 883
JO - BJOG - An International Journal of Obstetrics and Gynaecology
JF - BJOG - An International Journal of Obstetrics and Gynaecology
IS - 7
ER -