Clinical and Economic Evaluation of Surfactant Use in the Management of Meconium Aspiration Syndrome in the Intensive: Care Setting In Qatar

الموضوعات

طب

الملخص

Background. Surfactant replacement therapy is widely used in the management of thelife-threatening condition of Meconium Aspiration Syndrome (MAS), with no clearguidance on its best use. This thesis constitutes two phases. Phase one was to conducta systematic overview of literature systematic reviews (SRs) and randomized clinicaltrials (RCTs) on surfactant therapy in neonatal MAS. Phase two was to evaluate theclinical and economic impact of surfactant use in MAS management in the NICUsetting in Qatar, including different surfactant dosing regimens.Methods. For the SR, we searched EMBASE, PROQUEST and PubMed to summarizethe different effects of surfactant lung lavage (SLL) and bolus surfactant (BS) therapiesin neonates with MAS. Phase two of the thesis was a retrospective cost-effectivenessanalyses to evaluate critically ill neonates with MAS receiving surfactant versusstandard care, and those receiving single versus multiple dosing surfactant therapy atNICUs in Hamad Medical Corporation (HMC), Qatar. Available medical records in theduration from 2014 to 2019 were utilized. Decision-analytic models from the hospitalperspective were designed to measure all the possible consequences of all comparisons.The base case of the model was analyzed based on a multivariate analysis via MonteCarlo simulation. Primary endpoints were treatment success defined as improvementsin oxygenation over baseline 24 h after treatment, evaluated by the reduction of oxygenindex (OI) to less than 10, and the overall direct medical cost of therapy. Sample sizewas calculated to achieve results with 80% power and a significance level of 0.05. Sensitivity analyses were conducted to enhance the robustness and generalizability ofthe results.Results. With a total of 1,377 patients, three SRs and two RCTs were included in ourSR analysis. Surfactant effectiveness was concluded by low-quality SRs, with high riskof bias, which was contradicted by high-quality SRs, with low risk of bias. In SRs, theSLL reduced mortality, need for extracorporeal membrane oxygenation, andhospitalization, while the BS did not. In recent high-quality RCTs, however, the twomodalities did not significantly differ. For the cost-effectiveness evaluation in phasetwo of the thesis, the standard care achieved a success of 75% versus 51% withsurfactant (odd ratio = 2.84; P = 0.029). The surfactant use was dominated by thestandard care in MAS, with cost-saving of QAR 48,653 per patient in favor of the latter.Single dose surfactant dominated the multiple doses regimen, with a cost saving ofQAR 12,582 per patient and a 57% treatment success, compared to 33% (odd ratio =1.2; P = 0.839). Here, the study groups did not achieve the calculated sample size and,hence, the evaluation was piloting in nature. Sensitivity analyses demonstrated therobustness of all study conclusions.Conclusion. The literature evidence on surfactant effectiveness and its method ofadministration is sparse and inconsistent. Based on the first cost-effectivenessevaluations of surfactant use in MAS in the literature. Standard care was cost effectiveand dominant over surfactant therapy in both clinical and economic outcomes. A costanalysis of single dose surfactant therapy versus the multiple dosing approachdemonstrated overall cost savings with the single dosing approach. The results supportthe recent trend by some HMC practitioners of favoring standard care over surfactantin the NICU practices of HMC.

روابط وملفات

التعريف والنوع

رقم الوثيقة

046a1c47-b4c6-48b6-8785-56f8e306cd20

رقم العقد

0

نوع الوسائط

Crawler

نوع المحتوى

الرسائل العلمية

صيغة المصدر

رسائل ماجيستير

نوع الملف

pdf text

أسماء الملفات

2018191_1.pdf

بيانات النشر

ألقاب المؤلفين

[{"name_ar":"داود البدرييه ","title_ar":"اشراف","title_en":"Supervision"},{"name_ar":"محمد أحمد عبد العال محمد","title_ar":"اعداد","title_en":"Preparation"}]

اللغة

English

المصدر والدورية

اسم المصدر

Clinical and Economic Evaluation of Surfactant Use in the Management of Meconium Aspiration Syndrome in the Intensive: Care Setting In Qatar

المحتوى والصفحات

عدد الصفحات

0

إشراف وإعداد

الإشراف

داود البدرييه

الإعداد

محمد أحمد عبد العال محمد

الاقتباسات الببليوغرافية