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J Korean Med Assoc > Volume 54(5); 2011 > Article
Choi, Suh, Hahn, Lee, Park, Lee, Kim, and Bae: The burden of illness for meconium aspiration syndrome and cost prediction related to surfactant therapy for meconium aspiration syndrome in Korea

Abstract

Meconium aspiration syndrome (MAS) is an important cause of respiratory distress in neonates. Surfactant therapy has been used to improve oxygenation for infants with MAS recently. The object of this study is to estimate the number of candidates for surfactant use in MAS and the cost for surfactant, and to analyze its cost-effectiveness in Korea. Using Korean Health Insurance Review and Assessment Service reimbursement data, the number of neonates with a diagnosis of MAS receiving mechanical ventilation was counted. The annual cost for surfactant use was calculated using the number of patients receiving mechanical ventilation for at least three days who were considered potential candidates for surfactant use. The cost-effectiveness was evaluated using the effectiveness data from a previous meta-analysis. Infants with a diagnosis of MAS receiving mechanical ventilation were 0.92 per 1,000 live births annually. Among them, 55% were potential candidates for surfactant use. The expected annual cost for surfactant was 990 million Korean won and 500 million Korean won and the number needed to treat was 14.3 and 6.7 in surfactant bolus therapy and surfactant lavage therapy, respectively. Sixty-four million won was estimated as the cost to prevent one infant death by surfactant bolus therapy and 15 million won by surfactant lavage therapy. The surfactant therapy for MAS is presently not covered by the Korean national health insurance and its application to MAS is limited because of the high financial burden to the patients' family. This study's results could help healthcare decision makers establish a policy in the future.

Acknowledgement

This work was supported by a project grant from the National Evidence-based Healthcare Collaborating Agency of Korea as part of a Health Technology Assessment (project no. NA2010-009). We also thank the clinical expert advisory group from the Korean Society of Neonatology for their valuable advice and suggestions during the conduct of the study.

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Figure 1
Meta-analysis of risk difference according to surfactant use. RD, risk difference; CI, confidence interval.
jkma-54-549-g001-l.jpg
Table 1
Artificial surfactant available in Korea
jkma-54-549-i001-l.jpg
Table 2
Distribution of infants with mechanical ventilation for meconium aspiration syndrome in the Korea National Health Insurance Claims Database
jkma-54-549-i002-l.jpg

The number in parenthesis indicates the number of patients per 1,000 live births.

A p-value of test for yearly difference in prevalence was 0.06.

Table 3
Distribution of infants with mechanical ventilation at least for three days in meconium aspiration syndrome from the Korea National Health Insurance Claims Database
jkma-54-549-i003-l.jpg

The number in parenthesis indicates the number of patients per 1,000 live births.

Table 4
Cost effect of surfactant use
jkma-54-549-i004-l.jpg

NNT, number needed to treat.

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