Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: A systematic review
Summary: Background: Preterm birth is a leading cause of neonatal mortality and morbidity, and imposes high health and societal costs. Antenatal corticosteroids (ACS) to accelerate fetal lung maturation are commonly used in conjunction with tocolytics for arresting preterm labour in women at risk o...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-07-01
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| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537022002267 |
| _version_ | 1828807830859153408 |
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| author | Elizabeth Sebastian Chloe Bykersma Alexander Eggleston Katherine E. Eddy Sher Ting Chim Rana Islamiah Zahroh Nick Scott Doris Chou Olufemi T. Oladapo Joshua P. Vogel |
| author_facet | Elizabeth Sebastian Chloe Bykersma Alexander Eggleston Katherine E. Eddy Sher Ting Chim Rana Islamiah Zahroh Nick Scott Doris Chou Olufemi T. Oladapo Joshua P. Vogel |
| author_sort | Elizabeth Sebastian |
| collection | DOAJ |
| description | Summary: Background: Preterm birth is a leading cause of neonatal mortality and morbidity, and imposes high health and societal costs. Antenatal corticosteroids (ACS) to accelerate fetal lung maturation are commonly used in conjunction with tocolytics for arresting preterm labour in women at risk of imminent preterm birth. Methods: We conducted a systematic review on the cost-effectiveness of ACS and/or tocolytics as part of preterm birth management. We systematically searched MEDLINE and Embase (December 2021), as well as a maternal health economic evidence repository collated from NHS Economic Evaluation Database, EconLit, PubMed, Embase, CINAHL and PsycInfo, with no date cutoff. Eligible studies were economic evaluations of ACS and/or tocolytics for preterm birth. Two reviewers independently screened citations, extracted data on cost-effectiveness and assessed study quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Findings: 35 studies were included: 11 studies on ACS, eight on tocolytics to facilitate ACS administration, 12 on acute and maintenance tocolysis, and four studies on a combination of ACS and tocolytics. ACS was cost-effective prior to 34 weeks’ gestation, but economic evidence on ACS use at 34-<37 weeks was conflicting. No single tocolytic was identified as the most cost-effective. Studies disagreed on whether ACS and tocolytic in combination were cost-saving when compared to no intervention. Interpretation: ACS use prior to 34 weeks’ gestation appears cost-effective. Further studies are required to identify what (if any) tocolytic option is most cost-effective for facilitating ACS administration, and the economic consequences of ACS use in the late preterm period. Funding: UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by WHO. |
| first_indexed | 2024-12-12T08:31:43Z |
| format | Article |
| id | doaj.art-a18ffccd9928461c92830df29a1f085c |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-12-12T08:31:43Z |
| publishDate | 2022-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-a18ffccd9928461c92830df29a1f085c2022-12-22T00:31:05ZengElsevierEClinicalMedicine2589-53702022-07-0149101496Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: A systematic reviewElizabeth Sebastian0Chloe Bykersma1Alexander Eggleston2Katherine E. Eddy3Sher Ting Chim4Rana Islamiah Zahroh5Nick Scott6Doris Chou7Olufemi T. Oladapo8Joshua P. Vogel9Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, AustraliaMaternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, AustraliaMaternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, AustraliaMaternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, AustraliaMaternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, AustraliaGender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, AustraliaMaternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, AustraliaUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandMaternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Corresponding author at: Burnet Institute, Melbourne, Australia.Summary: Background: Preterm birth is a leading cause of neonatal mortality and morbidity, and imposes high health and societal costs. Antenatal corticosteroids (ACS) to accelerate fetal lung maturation are commonly used in conjunction with tocolytics for arresting preterm labour in women at risk of imminent preterm birth. Methods: We conducted a systematic review on the cost-effectiveness of ACS and/or tocolytics as part of preterm birth management. We systematically searched MEDLINE and Embase (December 2021), as well as a maternal health economic evidence repository collated from NHS Economic Evaluation Database, EconLit, PubMed, Embase, CINAHL and PsycInfo, with no date cutoff. Eligible studies were economic evaluations of ACS and/or tocolytics for preterm birth. Two reviewers independently screened citations, extracted data on cost-effectiveness and assessed study quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Findings: 35 studies were included: 11 studies on ACS, eight on tocolytics to facilitate ACS administration, 12 on acute and maintenance tocolysis, and four studies on a combination of ACS and tocolytics. ACS was cost-effective prior to 34 weeks’ gestation, but economic evidence on ACS use at 34-<37 weeks was conflicting. No single tocolytic was identified as the most cost-effective. Studies disagreed on whether ACS and tocolytic in combination were cost-saving when compared to no intervention. Interpretation: ACS use prior to 34 weeks’ gestation appears cost-effective. Further studies are required to identify what (if any) tocolytic option is most cost-effective for facilitating ACS administration, and the economic consequences of ACS use in the late preterm period. Funding: UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by WHO.http://www.sciencedirect.com/science/article/pii/S2589537022002267Cost-effectivenessEconomic evaluationPreterm birthAntenatal corticosteroidsTocolysisTocolytic |
| spellingShingle | Elizabeth Sebastian Chloe Bykersma Alexander Eggleston Katherine E. Eddy Sher Ting Chim Rana Islamiah Zahroh Nick Scott Doris Chou Olufemi T. Oladapo Joshua P. Vogel Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: A systematic review EClinicalMedicine Cost-effectiveness Economic evaluation Preterm birth Antenatal corticosteroids Tocolysis Tocolytic |
| title | Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: A systematic review |
| title_full | Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: A systematic review |
| title_fullStr | Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: A systematic review |
| title_full_unstemmed | Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: A systematic review |
| title_short | Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: A systematic review |
| title_sort | cost effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth a systematic review |
| topic | Cost-effectiveness Economic evaluation Preterm birth Antenatal corticosteroids Tocolysis Tocolytic |
| url | http://www.sciencedirect.com/science/article/pii/S2589537022002267 |
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