Which surfactant is cost-effective in Neonatal Respiratory Distress Syndrome?

Neonatal Respiratory Distress Syndrome (NRDS) is the most common cause of hospitalization and preterm birth and one of the leading causes of death in newborns. The main intervention is surfactant therapy. This study aimed to determine the cost-effectiveness of Calfactant compared to Beractant and Poractant alfa in treating preterm infants with RDS in Iran. A two-state decision tree model was developed based on RDS disease pathways, assuming that neonates had been admitted to the NICU using one of the aforementioned surfactants. Efficacy as life years gained (LYG) and transition probabilities between states were extracted from international RCTs. Costs are presented in US dollars, and the incremental cost-effectiveness ratio (ICER) is presented from the Iranian healthcare system perspective. To evaluate the model’s robustness against data uncertainties, the study conducted both deterministic (one-way and two-way) and probabilistic sensitivity analyses, including a Monte Carlo simulation, using varied input ranges and distributional modeling, with results visualized through tornado plots and scatter plots. From the Iranian healthcare system perspective, in RDS preterm neonates, Calfactant was cost-effective versus Beractant. However, it is not cost-effective compared to Poractant alfa.