140 Preventing Respiratory Distress Syndrome: A Comparative Pharmacoeconomic Analysis of Lucinactant (Surfaxin) Versus Pooled Animal-Derived Surfactants

Abstract

Background: Lucinactant (Surfaxin®) is the first available synthetic surfactant containing a peptide (sinapultide; KL4) that mimics human SP-B. There are currently no published pharmacoeconomic analyses comparing lucinactant to the animal-derived surfactants in the prevention of respiratory distress syndrome (RDS) in very low birth weight (VLBW) pre-term infants.Objectives: To estimate the clinical consequences and economic impact of lucinactant and pooled animal-derived surfactants (beractant [Survanta®] and poractant alfa [Curosurf®]) in the prevention of RDS among surviving pre-term infants weighing 600 to 1,250 grams.Methods: A decision-analytic model was constructed using a hospital perspective to assess the pharmacoeconomics of surfactant replacement therapy. Data sources: a) epidemiologic data regarding low birth weight and VLBW infants is from the U.S. National Centers for Health Statistics (2003), and the Vermont Oxford Network (2004); b) clinical outcomes are from two randomized, controlled clinical trials of surfactant therapy (SELECT and STAR); and c) cost data is from an assessment of daily neonatal intensive care unit (NICU) costs for 244 pre-term infants with severe RDS (2004). Cost variables: Average cost of a day in the NICU on mechanical ventilation (MV) was U.S. $2,386 and was U.S. $1,565 off MV; surfactant pharmacy costs were included at price parity from the Red Book (2005).Results: Surviving infants who received lucinactant compared to pooled animal-derived surfactants had 4.14 fewer NICU days (mean 75.68 days vs. 79.82 days, respectively). Fewer NICU days convert into a total cost savings per infant who survived of U.S. $5,841 in the lucinactant group compared to the pooled animal-derived cohort. Conclusions: When compared to pooled animal-derived surfactants, the synthetic surfactant lucinactant may reduce total initial NICU hospital costs in surviving infants who receive surfactant therapy.