Economic Evaluation alongside the Trial of Selective Early Treatment of Patent Ductus Arteriosus with Ibuprofen in Extreme Preterm Babies
Bibliographic record
Abstract
Abstract Objective To conduct an economic evaluation alongside the placebo-controlled trial of selective early treatment of patent ductus arteriosus with ibuprofen in extreme preterm babies. Design Within-trial economic evaluation alongside a multicentre, randomized, masked, placebo-controlled trial. Setting Thirty-two UK tertiary neonatal intensive care units. Sample Babies born between 23 +0 to 28 +6 weeks’ gestation, less than 72 hours old and confirmed by echocardiography to have a large PDA. Methods A cost-effectiveness analysis was conducted from the National Health Service (NHS) and NHS and Personal Social Services perspectives. Nonparametric bootstrapping was used to estimate incremental costs and outcomes which were reported as cost-effectiveness acceptability curves. Main outcome measures Cost per additional major outcome averted. Results Ibuprofen is less costly with an average cost per participant of £126,465 compared to £133,260 (-£6,808 (95% CI: £-17,154 to £3,537) for placebo. But it is less effective in terms of major outcomes averted with an absolute effect difference of 0.054 (95% CI: -0.014 to 0.121). The differences in mean cost were mainly attributable to the costs of high dependency care (£2,345, 95% CI -£3,435 to £8,126) and intensive care (£6,718, 95% CI - £12,627 to £26,063) which were higher in the placebo arm. The incremental cost-effectiveness ratio was estimated at £126,846 for an additional case of death, or severe or moderate bronchopulmonary dysplasia avoided by 36 weeks of post-menstrual age. Conclusions Based on the evidence from this trial, ibuprofen would not be recommended. There is insufficient evidence to suggest that any of the observed detrimental impact on effectiveness would be outweighed by the opportunity cost associated of any saving in costs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.043 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.007 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".