TY - JOUR
T1 - Antenatal dexamethasone for improving preterm newborn outcomes in low-resource countries
T2 - a cost-effectiveness analysis of the WHO ACTION-I trial
AU - Eddy, Katherine E.
AU - Vogel, Joshua P.
AU - Scott, Nick
AU - Fetene, Dagnachew
AU - Tidhar, Tom
AU - Oladapo, Olufemi T.
AU - Piaggio, Gilda
AU - Nguyen, My Huong
AU - Althabe, Fernando
AU - Bahl, Rajiv
AU - Rao, Suman P.N.
AU - De Costa, Ayesha
AU - Gupta, Suchita
AU - Baqui, Abdullah H.
AU - Shahidullah, Mohammod
AU - Chowdhury, Saleha Begum
AU - Ahmed, Salahuddin
AU - Sultana, Saima
AU - Jaben, Iffat Ara
AU - Goudar, Shivaprasad S.
AU - Dhaded, Sangappa M.
AU - Pujar, Yeshita V.
AU - Vernekar, Sunil S.
AU - Welling, Saraswati
AU - Katageri, Geetanjali M.
AU - Gudadinni, Muttappa R.
AU - Nanda, Saumya
AU - Qureshi, Zahida
AU - Baraka, Harriet Tunu
AU - Osoti, Alfred
AU - Gwako, George
AU - Kinuthia, John
AU - Ojo, Samuel
AU - Adeponle, Adesina Olubukola
AU - Idowu, Ayede Adejumoke
AU - Adejuyigbe, Ebunoluwa Aderonke
AU - Kuti, Oluwafemi
AU - Kuti, Bankole Peter
AU - Akinkunmi, Francis Bola
AU - Kubeyinje, Weyinmi Emmanuel
AU - Raji, Hadijat Olaide
AU - Abiodun, Olusanya
AU - Isah, Anthony Dennis
AU - Ariff, Shabina
AU - Soofi, Sajid Bashir
AU - Sheikh, Lumaan
AU - Aamir, Almas
AU - Raza, Farrukh
AU - WHO ACTION Trial Collaborators
N1 - Funding Information:
We thank the women and infants who participated in this study, as well as the physicians, midwives, pharmacists, data managers, and research assistants who helped conduct the WHO ACTION-I trial. We acknowledge the contributions of Nancy N Mose, Elizabeth Lubembe, Diana Khaemba, Salome Mahelo, Jane Munjuri, Bhavna Koppad, Bhuvaneshwari C Yelamali, Sangamesh S Mathapati, Mallanagouda M Patil, Hidaytullah R Bijapure, Sujata Misra, and Rashmita B Nayak.
Publisher Copyright:
© 2022 World Health Organization; licensee Elsevier
PY - 2022/10
Y1 - 2022/10
N2 - Background: After considerable debate, there is now unequivocal evidence that use of antenatal corticosteroids improves outcomes in preterm neonates when used in women at risk of early preterm birth in reasonably equipped hospitals in low-resource countries. We aimed to evaluate the cost-effectiveness of dexamethasone administration in the management of preterm birth in a cohort of pregnant women from five low-resource countries. Methods: We performed a cost-effectiveness analysis using data from 2828 women (and 3051 babies) who participated in the WHO ACTION-I trial, a multicentre, randomised, placebo-controlled trial that assessed the safety and efficacy of dexamethasone in pregnant women at risk of early preterm birth in 29 hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan. We used a decision tree model to assess the cost-effectiveness of dexamethasone treatment compared with no intervention from a health-care sector perspective. Outcome data were taken from the primary results of the trial and primary data on cost were collected in 28 hospitals. The primary cost-effectiveness outcome was cost per neonatal death or the cost per disability-adjusted life-years (DALYs) averted, or costs saved per 1000 woman–baby units if the intervention was found to be cost-saving. Findings: Administration of dexamethasone averted 38 neonatal deaths per 1000 woman–baby units and 1132 DALYs per 1000 woman–baby units. Compared with no intervention, use of antenatal corticosteroids was cost-saving in all five countries, ranging from a saving of US$1778 per 1000 woman–baby units (95% uncertainty interval [UI] –13 878 to 9483) in Nigeria, to $20 531 per 1000 woman–baby units (–46 387 to 4897) in Pakistan, to $36 870 per 1000 woman–baby units (–61 569 to –15 672) in Bangladesh, to $38 303 per 1000 woman–baby units (–64 183 to –10 753) in India, and to $53 681 per 1000 woman–baby units (–113 822 to 2394) in Kenya. Findings remained consistent following sensitivity analyses. In all five countries, dexamethasone was more effective and cost less compared with no treatment. Interpretation: Antenatal dexamethasone for early preterm birth was cost-saving when used in hospitals in low-resource countries. Decision makers in low-resource settings can be confident that use of antenatal dexamethasone for early preterm birth is cost-effective, and often cost-saving when used in reasonably equipped hospitals in low-resource countries. Funding: Bill & Melinda Gates Foundation and WHO.
AB - Background: After considerable debate, there is now unequivocal evidence that use of antenatal corticosteroids improves outcomes in preterm neonates when used in women at risk of early preterm birth in reasonably equipped hospitals in low-resource countries. We aimed to evaluate the cost-effectiveness of dexamethasone administration in the management of preterm birth in a cohort of pregnant women from five low-resource countries. Methods: We performed a cost-effectiveness analysis using data from 2828 women (and 3051 babies) who participated in the WHO ACTION-I trial, a multicentre, randomised, placebo-controlled trial that assessed the safety and efficacy of dexamethasone in pregnant women at risk of early preterm birth in 29 hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan. We used a decision tree model to assess the cost-effectiveness of dexamethasone treatment compared with no intervention from a health-care sector perspective. Outcome data were taken from the primary results of the trial and primary data on cost were collected in 28 hospitals. The primary cost-effectiveness outcome was cost per neonatal death or the cost per disability-adjusted life-years (DALYs) averted, or costs saved per 1000 woman–baby units if the intervention was found to be cost-saving. Findings: Administration of dexamethasone averted 38 neonatal deaths per 1000 woman–baby units and 1132 DALYs per 1000 woman–baby units. Compared with no intervention, use of antenatal corticosteroids was cost-saving in all five countries, ranging from a saving of US$1778 per 1000 woman–baby units (95% uncertainty interval [UI] –13 878 to 9483) in Nigeria, to $20 531 per 1000 woman–baby units (–46 387 to 4897) in Pakistan, to $36 870 per 1000 woman–baby units (–61 569 to –15 672) in Bangladesh, to $38 303 per 1000 woman–baby units (–64 183 to –10 753) in India, and to $53 681 per 1000 woman–baby units (–113 822 to 2394) in Kenya. Findings remained consistent following sensitivity analyses. In all five countries, dexamethasone was more effective and cost less compared with no treatment. Interpretation: Antenatal dexamethasone for early preterm birth was cost-saving when used in hospitals in low-resource countries. Decision makers in low-resource settings can be confident that use of antenatal dexamethasone for early preterm birth is cost-effective, and often cost-saving when used in reasonably equipped hospitals in low-resource countries. Funding: Bill & Melinda Gates Foundation and WHO.
UR - http://www.scopus.com/inward/record.url?scp=85137834927&partnerID=8YFLogxK
U2 - 10.1016/S2214-109X(22)00340-0
DO - 10.1016/S2214-109X(22)00340-0
M3 - Article
C2 - 36113535
AN - SCOPUS:85137834927
SN - 2214-109X
VL - 10
SP - e1523-e1533
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 10
ER -