Surfactant therapy has become an integral part of the standard of care for treating premature infants with respiratory distress syndrome (RDS). Institutions that routinely treat this patient population have to select a surfactant based upon clinical and pharmacoeconomic considerations. Pharmacoeconomic studies have established the cost-effectiveness of individual agents based on a variety of factors, including length of hospitalization, mortality odds ratio, and other direct medical costs. These studies evaluated infants with weights between 600 and 2000 grams and survival periods between 28 days and 1 year. With the cost-effectiveness of surfactants already established as being far superior to no treatment, trials have evolved to compare the available surfactants. Two studies have supported the cost-effectiveness of beractant compared to colfosceril or calfactant. Two others demonstrated lower resource utilization associated with poractant alfa as compared to beractant or calfactant. Evolving treatment approaches in the management of neonatal RDS, such as recent data suggesting continuous positive airway pressure as an alternative to mechanical ventilation for respiratory support, have defined the need to further evaluate the impact of such strategies upon surfactant and resource utilization.

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