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Open Access Research article

Magnesium sulphate for fetal neuroprotection: a cost-effectiveness analysis

Celeste D Bickford1*, Laura A Magee2, Craig Mitton1, Marie Kruse3, Anne R Synnes4, Diane Sawchuck5, Melanie Basso6, Vyta M Senikas7, Peter von Dadelszen5 and on behalf of the MAG-CP Working Group

Author Affiliations

1 School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada

2 Department of Medicine, Division of Internal Medicine, University of British Columbia, Vancouver, Canada

3 Danish Institute for Health Services Research, Copenhagen, Denmark

4 Department of Pediatrics, Division of Neonatology, Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada

5 Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of British Columbia, Vancouver, Canada

6 Children’s & Women’s Health Centre of British Columbia, Perinatal Health Program, Vancouver, Canada

7 Faculty of Medicine, McGill University, Montreal, Canada

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BMC Health Services Research 2013, 13:527  doi:10.1186/1472-6963-13-527

Published: 19 December 2013

Abstract

Background

The aim of this study was to assess the cost-effectiveness of administering magnesium sulphate to patients in whom preterm birth at < 32+0 weeks gestation is either imminent or threatened for the purpose of fetal neuroprotection.

Methods

Multiple decision tree models and probabilistic sensitivity analyses were used to compare the administration of magnesium sulphate with the alternative of no treatment. Two separate cost perspectives were utilized in this series of analyses: a health system and a societal perspective. In addition, two separate measures of effectiveness were utilized: cases of cerebral palsy (CP) averted and quality-adjusted life years (QALYs).

Results

From a health system and a societal perspective, respectively, a savings of $2,242 and $112,602 is obtained for each QALY gained and a savings of $30,942 and $1,554,198 is obtained for each case of CP averted when magnesium sulphate is administered to patients in whom preterm birth is imminent. From a health system perspective and a societal perspective, respectively, a cost of $2,083 is incurred and a savings of $108,277 is obtained for each QALY gained and a cost of $28,755 is incurred and a savings of $1,494,500 is obtained for each case of CP averted when magnesium sulphate is administered to patients in whom preterm birth is threatened.

Conclusions

Administration of magnesium sulphate to patients in whom preterm birth is imminent is a dominant (i.e. cost-effective) strategy, no matter what cost perspective or measure of effectiveness is used. Administration of magnesium sulphate to patients in whom preterm birth is threatened is a dominant strategy from a societal perspective and is very likely to be cost-effective from a health system perspective.

Keywords:
Magnesium sulphate; Fetal neuroprotection; Preterm birth; Cerebral palsy; Cost-effectiveness