Pretermlerde respiratuvar distres sendromu tedavisinde kullanılan üç farklı doğal surfaktan preparatının maliyet etkinliğinin karşılaştırılması

Year 2025, Volume: 50 Issue: 1, 73 - 82, 31.03.2025

Mustafa Şenol Akın , Ufuk Çakır

https://doi.org/10.17826/cumj.1589006

Abstract

Amaç: Bu çalışma, üç doğal surfaktanın maliyet-etkinliğini, respiratuvar ve kan gazı değişkenleri üzerindeki başlangıç etkileri ve ilişkili maliyetleri analiz ederek değerlendirmeyi amaçlamıştır.
Gereç ve Yöntem: Bu çalışmaya, Eylül 2019 ile Aralık 2022 tarihleri arasında üçüncü basamak yenidoğan yoğun bakım ünitesinde (YYBÜ) eksojen surfaktan replasman tedavisi almış, 32. gebelik haftasından önce doğmuş respiratuvar distres sendromu (RDS) tanılı preterm bebekler dahil edilmiştir. 985 hastaya ait veriler tıbbi kayıtlardan retrospektif olarak elde edilmiştir.
Bulgular: Çalışmaya dahil edilen hastaların %58’i (n=575) Poraktant Alfa, %35’i (n=343) Beraktant ve %7’si (n=67) Kalfaktant almıştır. Surfaktan grupları arasında kısa dönem pulmoner iyileşme, komplikasyonlar, klinik sonuçlar veya maliyetler açısından anlamlı bir fark gözlenmemiştir. Ancak, doğum ağırlıklarına göre yapılan alt grup analizinde, 750-999 gram ağırlığındaki bebeklerde Kalfaktant’ın (331,57±162,54 $), Beraktant (507,50±175,50 $) ve Poraktant Alfa’ya (472,44±93,73 $) göre anlamlı şekilde daha maliyet-etkin olduğu bulunmuştur. Ayrıca, 1000-1499 gram ağırlığındaki bebeklerde Beraktant (497,47±168,55 $) ve Kalfaktant’ın (531,54±293,20 $) Poraktant Alfa’ya (669,36±265,23 $) göre anlamlı şekilde daha düşük maliyetli olduğu görülmüştür.
Sonuç: Bu çalışma, surfaktan grupları arasında benzer kısa dönem respiratuvar iyileşme, komplikasyonlar ve klinik sonuçlar gözlemlendiğini, ancak maliyetin surfaktan seçiminde potansiyel olarak önemli bir rol oynayabileceğini göstermiştir. Doğum ağırlıklarına dayalı surfaktan seçimi için yeni bir model önerilmiştir. Buna göre, 750-999 gram ağırlığındaki bebekler için Kalfaktant’ın, 1000-1499 gram ağırlığındaki bebekler için ise Poraktant Alfa’nın tercih edilmesi önerilmektedir.

Keywords

Prematüre bebekler, Neonatal Respiratuvar Distres Sendromu, Pulmoner Surfaktanlar, Maliyet Etkinliği

Cost-effectiveness comparison of three different natural surfactant preparations in the treatment of preterm infants with respiratory distress syndrome

Abstract

Purpose: This study aimed to assess the cost-effectiveness of three natural surfactants by analyzing their initial impact on respiratory and blood gas variables and their associated costs.
Materials and Methods: This study included preterm infants with respiratory distress syndrome (RDS) born before the 32nd gestational week who received exogenous surfactant replacement therapy in a tertiary neonatal intensive care unit (NICU) between September 2019 and December 2022. Data from 985 patients were retrospectively obtained from medical records.
Results: Among the enrolled patients, 575 received Poractant Alfa (58%), 343 received Beractant (35%), and 67 received Calfactant (7%). No significant differences were observed between the surfactant groups in terms of short-term pulmonary improvement, complications, clinical outcomes, or costs. However, in subgroup analysis based on birth weights, Calfactant (331.57±162.54 $) was found to be significantly more cost-effective than Beractant (507.50±175.50 $) and Poractant Alfa (472.44±93.73 $) for infants weighing 750-999 grams. Furthermore, for infants weighing 1000-1499 grams, both Beractant (497.47±168.55 $) and Calfactant (531.54±293.20 $) were significantly less costly than Poractant Alfa (669.36±265.23 $).
Conclusions: This study demonstrated comparable short-term respiratory improvements, complications, and clinical outcomes among surfactant groups, emphasizing the potential influence of cost on surfactant choice. A novel model for selecting surfactant preparations based on birth weights was proposed, suggesting the use of Calfactant for infants weighing 750-999 grams and considering the use of Poractant Alfa for infants weighing 1000-1499 grams.

Keywords

Premature infants, Neonatal Respiratory Distress Syndrome, Pulmonary Surfactants, Cost Effectiveness

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