Cost-effectiveness Analysis of Ibuprofen versus Indomethacin or Paracetamol for the Treatment of Patent Ductus Arteriosus in Preterm Neonates

Abstract

Objective: This thesis sought to evaluate the cost-effectiveness of oral paracetamol and intravenous (IV) indomethacin as alternatives to ibuprofen for patent ductus arteriosus (PDA) in neonates in Hamad Medical Corporation (HMC), Qatar. Methods: Decision-analytic, literature-based, economic simulation models were constructed, from the hospital perspective, to evaluate oral/IV ibuprofen versus IV indomethacin, and oral/IV ibuprofen versus oral paracetamol, as first-line therapies for PDA closure. Cost model inputs were HMC based, and therapy success was defined as PDA closure with/without adverse events. Results: Oral ibuprofen is dominant/cost-effective over IV indomethacin in 92% of simulated cases, but oral paracetamol was 82% dominant/cost-effective over oral ibuprofen. Against IV ibuprofen, IV indomethacin was 59% dominant/cost-effective, whereas oral paracetamol was dominant/cost-effective in 91% of the cases. Sensitivity analyses confirmed the study's robustness. Conclusion: For PDA closure, while IV indomethacin was cost-effective against IV ibuprofen, oral paracetamol was cost-effective against both oral and IV ibuprofen.