Resuscitation of likely nonviable infants: a cost-utility analysis after the Born-Alive Infant Protection Act.
Am J Obstet Gynecol
; 206(1): 49.e1-49.e10, 2012 Jan.
Article
em En
| MEDLINE
| ID: mdl-22051817
ABSTRACT
OBJECTIVE:
The purpose of this study was to compare the effects of universal vs selective resuscitation on maternal utilities, perinatal costs, and outcomes of preterm delivery and termination of pregnancy at 20-23 weeks 6 days' gestation. STUDYDESIGN:
We used studies on medical practices, prematurity outcomes, costs, and maternal utilities to construct decision-analytic models for a cohort of annual US deliveries after preterm delivery or induced termination. Outcome measures were (1) the numbers of infants who survived intact or with mild, moderate, or severe sequelae; (2) maternal quality-adjusted life years (QALYs); and (3) incremental cost-effectiveness ratios.RESULTS:
Universal resuscitation of spontaneously delivered infants between 20-23 weeks 6 days' gestation increases costs by $313.1 million and decreases QALYs by 329.3 QALYs; after a termination, universal resuscitation increases costs by $15.6 million and decreases QALYs by 19.2 QALYs. With universal resuscitation, 153 more infants survive 44 infants are intact or mildly affected; 36 infants are moderately impaired, and 73 infants are severely disabled.CONCLUSION:
Selective intervention constitutes the highest utility and least costly treatment for infants at the margin of viability.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ressuscitação
/
Unidades de Terapia Intensiva Neonatal
/
Nascimento Prematuro
Tipo de estudo:
Etiology_studies
/
Health_economic_evaluation
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
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Humans
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Newborn
/
Pregnancy
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article