Cost effectiveness of surfactant replacement in preterm babies.

Surfactant replacement in preterm babies has been shown in recent years in randomised controlled trials to be an effective treatment for respiratory distress syndrome (RDS). It is expensive and, because it increases survival, it has implications for the costs of neonatal services. We used evidence about resource use obtained from trials of surfactant and other studies on the economics of surfactant to assess the cost effectiveness of different policies for its use. For the smallest babies, surfactant is likely to increase overall costs of neonatal care, but also to reduce the ratio of costs to survival, whether surfactant is given prophylactically or as a treatment for established RDS. It is less clear what the optimal policy should be for babies of more than around 31 weeks' gestation. Comparison of the relative cost effectiveness of policies of early prophylactic surfactant and surfactant for later treatment of RDS, and of different dosage policies, is currently being conducted in the context of 2 large multicentre trials. No policy for surfactant use should be considered in isolation from the availability of effective obstetric interventions which have been shown to reduce the risk of RDS in preterm babies and which will therefore reduce the need for surfactant.