Abstract
Background:
Immature lungs need surfactant administration due to lack of adequate production prior to 32 weeks gestation. Surfactant reduces the surface tension within the lungs, allowing the alveoli to remain open. We utilized Brand A of surfactant until October 2018, patients required multiple doses. We were changed to Brand B by our formulary. Brand B presented that their product had greater efficacy and patients rarely needed more than 1 dose and even more infrequently needed more than 2. While the initial dose of Brand B is more expensive than Brand A, there was an expected cost savings due to decreased amount of subsequent administrations. Patients that required more than one dose were more likely to have greater amount of days on mechanical ventilation and other risk factors.
Methods:
A multidisciplinary team formed and evaluated risks and benefits of Brand A surfactant versus Brand B. Surfactant was administered to patients meeting the same criteria as Brand A; oxygen requirement above 30% while on mechanical ventilation and oxygen requirement above 40% on Bubble CPAP. We utilized our updated surfactant administration checklist to assure procedure was completed per policy and the number of doses documented. Subsequent doses of Brand B required half the initial dose, and Brand A required the same dose for initial and subsequent instillations. The outcome measure was the number of subsequent surfactant administrations and the overall cost to the patient. Process measures were compliance with audit completion for each administration and use of ventilator weaning protocol. Balancing measures were rate of patients that required reintubation and documented adverse events.
Results:
There were 84 patients administered Brand A (Bovine) and 50% required more than one dose. There were 86 patients administered Brand B (Porcine) and 66% of patients required one dose with no subsequent administrations. Patients that received Brand B that required more than one dose required a third dose less often than Brand A. The average cost for Brand A was $409.03 and Brand B average cost was $515.38 per administration.
Conclusions:
Brand B supported a statistical difference; P = .045, in the need for one dose versus subsequent doses. While Brand B is more expensive upfront, we were still able to reduce cost because there was a significant difference in the number of patients requiring only one dose.
Pvalue 0.045 View all access options for this article.Doses Per Brand
Brand A
Cost
Brand B
Cost
Number of patients:
84
$409.03
86
$515.38
Number of Doses Received:
151
$61,763.53
124
$63,907.12
1 dose:
42
57
2 doses:
18
20
3 doses:
23
9
4 doses:
1
0
Percentage needed only 1 dose
50%
66%
Date Range
3/9/2017-10/8/2018
10/9/2018-5/8/2020
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