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

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.