British researchers say giving inexpensive magnesium sulphate to women at risk of premature birth can reduce the chance of a child having cerebral palsy by at least a third – and costs just £1 per dose.
Yet, pointed out the authors of the observational study, published in Archives of Disease in Childhood – Foetal and Neonatal Edition, in 2017, only around two-thirds (64%) of eligible women were being given magnesium sulphate across Britain, with “wide regional variations”.
To address this, in 2014, the PReCePT (Preventing Cerebral Palsy in Pre Term labour) quality improvement toolkit was developed by both parents and staff aimed at supporting all maternity units in England to improve staff awareness and increase the use of magnesium sulphate in mothers at risk of giving birth at 30 weeks’ gestation or under.
The pilot study in 2015, which involved five maternity units, found an increase in uptake from 21% to 88% associated with the PReCePT approach, reports Medscape.
Subsequently, in 2018, NHS England funded the National PReCePT Programme, which scaled up the intervention for national roll-out and provided the PReCePT quality toolkit – which includes preterm labour proforma, staff training presentations, parent information leaflet, posters for the unit, and a learning log – to each maternity unit.
Improvement ‘over and above’ expectation
The first evaluation of a universally implemented national perinatal quality improvement programme to increase administration of an evidence-based drug was led by University of Bristol researchers, to examine the effectiveness and costs of the National PReCePT Programme in increasing use of magnesium sulphate in preterm births.
Using data from the UK National Neonatal Research Database for the year before and the year after PReCePT was implemented in maternity units in England, the teams performed a before-and-after study of 137 maternity units within NHS England.
Participants were babies born at 30 weeks’ gestation or under and admitted to neonatal units in England: the main outcome measure was magnesium sulphate uptake before and after the implementation of the National PReCePT Programme. Implementation and lifetime costs were also estimated.
During the first year, post implementation of the programme, uptake increased by an average of 6.3 percentage points (to 83.1%) across all maternity units in England, which the authors said was “over and above” the increase that would be expected over time as the practice spread organically. They also found that after adjusting for variations in when maternity units started the programme, the increase in use of magnesium sulphate was 9.5 percentage points. “By May 2020, on average 86.4% of eligible mothers were receiving magnesium sulfate,” they said.
Professor John Macleod, NIHR ARC West director, professor in clinical epidemiology and primary care, University of Bristol, and principal investigator of the evaluation, said: “Our in-depth analysis has demonstrated that the PReCePT programme is both effective and cost-effective. It has increased uptake of magnesium sulphate, a cost-effective medicine to prevent cerebral palsy, much faster than we expected.”
The health gains and cost savings associated with the National PReCePT Programme generated a “net monetary benefit of £866 per preterm baby,” with the probability of the programme being cost-effective being “greater than 95%,” the authors highlighted.
The researchers also estimated that the programme’s first year could be associated with a lifetime saving to society of £3m – which accounts for the costs of the programme, of administering the treatment, of cerebral palsy to society over a lifetime, and the associated health gains of avoiding cases. “This is across all the extra babies the programme helped get access to the treatment during the first year,” they said.
The authors highlighted that in the five pilot sites, the improved use of magnesium sulphate has been “sustained over the years” since PReCePT was implemented. As the programme costs were mostly in the first year of implementation, longer-term national analysis may show that PReCePT is “even more cost-effective over a longer period”, they said.
Study details
National PReCePT Programme: a before-and-after evaluation of the implementation of a national quality improvement programme to increase the uptake of magnesium sulphate in preterm deliveries
Hannah Edwards, Maria Theresa Redaniel, Carlos Sillero-Rejon, Ruta Margelyte, Tim Peters, Kate Tilling, William Hollingworth, Hugh McLeod, Pippa Craggs, Elizabeth Hill, Sabi Redwood, Jenny Donovan, Emma Treloar, Ellie Wetz, Natasha Swinscoe, Gary Ford, John Macleod, Karen Luyt.
Published in Archives of Disease in Childhood – Fetal and Neonatal Edition on 8 January 2023
Abstract
Objective
To evaluate the effectiveness and cost-effectiveness of the National PReCePT Programme (NPP) in increasing use of magnesium sulphate (MgSO4) in preterm births.
Setting
Maternity units (N=137) within NHS England and the Academic Health Science Network (AHSN) in 2018.
Interventions
The NPP was a quality improvement (QI) intervention including the PReCePT (Preventing Cerebral Palsy in Pre Term labour) QI toolkit and materials (preterm labour proforma, staff training presentations, parent leaflet, posters for the unit and learning log), regional AHSN-level support, and up to 90 hours funded backfill for a midwife ‘champion’ to lead implementation.
Main outcome measures
MgSO4 uptake post implementation was compared with pre-NPP implementation uptake. Implementation and lifetime costs were estimated.
Results
Compared with pre-implementation estimates, the average MgSO4 uptake for babies born ≤30 weeks’ gestation, in 137 maternity units in England, increased by 6.3 percentage points (95% CI 2.6 to 10.0 percentage points) to 83.1% post implementation, accounting for unit size, maternal, baby and maternity unit factors, time trends, and AHSN. Further adjustment for early/late initiation of NPP activities increased the estimate to 9.5 percentage points (95% CI 4.3 to 14.7 percentage points). From a societal and lifetime perspective, the health gains and cost savings associated with the NPP effectiveness generated a net monetary benefit of £866 per preterm baby and the probability of the NPP being cost-effective was greater than 95%.
Conclusion
This national QI programme was effective and cost-effective. National programmes delivered via coordinated regional clinical networks can accelerate uptake of evidence-based therapies in perinatal care.
Archives of Disease in Childhood – Fetal and Neonatal Edition article (Creative Commons Licence)
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