Cost-effectiveness of atosiban versus placebo for threatened preterm birth (APOSTEL 8 trial).
Larissa van der Windt, Martijn Oudijk, Job Klumper et al.
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In 30 seconds
This economic evaluation alongside the multicentre randomised APOSTEL 8 trial compared atosiban with placebo for threatened preterm birth at 30+0 to 33+6 weeks’ gestation. The intention-to-treat analysis included 752 participants (884 infants), with costs assessed from a societal perspective through three months’ corrected child age. Mean costs were similar: €40,743.1 with atosiban and €40,793.6 with placebo (mean difference -€50.5; 95% CI -4037.6 to 3936.7). Although the estimated incremental cost per severe adverse neonatal outcome prevented was dominant (-€5286.6), uncertainty was high, and the evaluation did not establish cost-effectiveness.
Key findings
- Mean costs were €40,743.1 with atosiban and €40,793.6 with placebo; the mean difference was -€50.5 (95% CI -4037.6 to 3936.7).
- The estimated incremental cost per severe adverse neonatal outcome prevented was -€5286.6, suggesting cost savings alongside fewer severe outcomes.
- Bootstrapped cost-effect pairs spanned all four cost-effectiveness-plane quadrants, indicating substantial uncertainty; the probability of cost-effectiveness reached 50% at €33,023.3 per outcome prevented.
Why it matters
Economic evaluations help determine whether a treatment’s costs are justified by its clinical outcomes. Here, the apparently favourable point estimate for atosiban was not robust to uncertainty, and the authors concluded that cost-effectiveness was not demonstrated. The findings therefore add economic evidence to assessment of atosiban for threatened preterm birth at this gestational age, while underscoring the uncertainty in the estimates.
What to keep in mind
Cost-effectiveness estimates were highly uncertain, with bootstrapped cost-effect pairs distributed across all four quadrants of the cost-effectiveness plane.