Cost of preterm birth during initial hospitalization: A care provider’s perspective

Abstract

Preterm birth incidence has risen globally and remains a major cause of neonatal mortality despite improved survival. Demand and cost of initial hospitalization has also increased. This study assessed the cost of preterm birth during initial hospitalization from care provider perspective in neonatal intensive care units (NICU) of two hospitals in the state of Kedah, Malaysia. It utilized universal sampling and prospectively followed up preterm infants till discharge. Care provider cost was assessed using mixed method of top down approach and activity based costing. A total of 112 preterm infants were recruited from intensive care (93 infants) and minimal care (19 infants) units. Majority were from the moderate (23%) and late (36%) preterm groups followed by very preterm (32%) and extreme preterm (9%). Median cost per infant increased with level of care and degree of prematurity. Cost was dominated by overhead (fixed) costs for general (hospital), intermediate (clinical support services) and final (NICU) cost centers where it constituted at least three quarters of admission cost per infant while the remainder was consumables (variable) cost. Breakdown of overhead cost showed NICU specific overhead contributing at least two thirds of admission cost per infant. Personnel salary made up three quarters of NICU specific overhead. Laboratory investigation was the cost driver for consumables. Gender, birth weight and length of stay were significant factors and cost prediction was developed with these variables. This study demonstrated the inverse relation between resource utilization, cost and prematurity and identified personnel salary as the cost driver. Cost estimates and prediction provide in-depth understanding of provider cost and are applicable for further economic evaluations. Since gender is non-modifiable and reducing LOS alone is not effective, birth weight as a cost predictive factor in this study can be addressed through measures to prevent or delay preterm birth.

Trends in Costs of Birth Hospitalization and Readmissions for Late Preterm Infants

“…Our study confirmed previous findings of higher birth hospitalization costs for LPIs compared to TIs regardless of study design, costing methodology, location and year of study [21,[29][30][31]. Studies conducted in the US showed 7-12-fold (average 7.8-fold in the present study) higher cost of initial hospitalization [21,32,33] compared to similar studies from other developed countries showing ~2-4-fold increase in initial hospitalization cost for LPIs [29,34,35]. A previous study examining initial hospitalization costs of a 1998-2000 California birth cohort showed six-fold higher costs of LPIs [36].…”

“…We observed a similar trend of increasing birth hospitalization cost of TIs by 3% during the studied period without any change in LOS but decreasing birth hospitalization cost for LPIs since 2013. Nonetheless, there is still a potential to reduce birth hospitalization cost for LPIs in the US considering other developed countries report lower differential birth hospitalization cost (~2–4 fold) for LPIs [ 29 , 34 , 35 ].…”

Predictors of very preterm births (born between 23 and 29 weeks’ gestation) at a tertiary care center in Karachi, Pakistan: additional multivariate analyses on data from primary cohort

“…[3]. Very preterm births also incur high costs as they require specialized care in intensive care nurseries and if survive beyond early months, then costs associated with health and education during the early years [4].…”

Hubungan Usia Ibu Hamil Dengan Kejadian Persalinan Prematur Di Rsud Panembahan Senopati Bantul Yogyakarta

“…Yogyakarta Persalinan prematur pada rentang sedang atau akhir yaitu umur kehamilan 32 minggu sampai kurang dari 37 minggu. Hal ini sejalan dengan beberapa penelitian yaitu menyatakan bahwa kelompok prematur sedang dan prematur akhir lebih dominan daripada kelompok prematur yang lainnya (Binalole et al, 2015;Zainal et al, 2019). Persalinan prematur sedang atau akhir (20-35 tahun) merupakan rentang usia kehamilan yang baik untuk kategori prematur.…”