A COST-EFFECTIVENESS ANALYSIS FOR HIGH VERSUS LOW DOSE CAFFEINE FOR THE TREATMENT OF APNEA IN NEONATAL INTENSIVE CARE UNIT

Abstract

Objective: This thesis sought to evaluate the cost effectiveness of high dose (HD) caffeine as alternative therapy over the standard low dose (LD) caffeine for apnea of prematurity (AOP) in neonates, in Hamad Medical Corporation (HMC), Qatar. Methods: A decision-analytic, literature-based, economic simulation model was constructed, from the hospital perspective, to evaluate high (20 mg/kg/dose) versus low (10 mg/kg/dose) maintenance caffeine doses as first-line therapy for AOP. The clinical data inputs were obtained from best available meta-analysis identified from systematic review conducted for this purpose. The cost model inputs were HMC based. Therapy success was defined as survival with <3 apnea episodes per day and successful extubation removal, with/without adverse events. Results: With 0.23 (95% CI, 0.23-0.23) enhancement in success rate, at QAR 14,084 (95% CI, 13,916-14,251) added patient cost, the HD caffeine costed QAR 61,500 (95% CI, 55,480-67,520) over LD caffeine per additional case of success. Sensitivity analyses confirmed the study robustness. Conclusion: For AOP, based on the willingness-to-pay threshold, HD caffeine seems to be a cost-effective alternative to LD caffeine in HMC.