Hospital Costs and Quality of Life During 4 Years After Very Preterm Birth

Abstract

To evaluate the effect of gestational age and prematurity-related morbidities on hospital costs and cost per quality-adjusted life-year (QALY) during the first 4 years of life.Design: Population-based study using national register data and parental questionnaires. Setting: Finland. Participants: All 2064 very preterm children (gestational age Ͻ32 weeks or birth weight Ͻ1501 g) and all 200 609 full-term control individuals (mean [SD] gestational age, 37 [0] to 41 [6] weeks) born from January 1, 2000, through December 31, 2003. Main Exposure: Prematurity. Main Outcome Measures: Costs of hospital care and cost per QALY at 4 years of age according to gestational age and prematurity-related morbidities. Results: By 4 years of age, the cost per QALY for fullterm controls (in 2008 currency) was €1181 (US$1736). In very preterm children, the average cost per QALY was €19 245 ($28 290), ranging from €11 824 to €54 324 ($17 381 to $79 856) and increasing with decreasing gestational age. The cost per QALY was €14 368 ($21 121)for those without any of the studied morbidities and €36 110 ($53 082) for those with 2 or more morbidities. The costs of the initial hospital stay comprised 79.5% of the total 4-year hospital costs in very preterm children. Conclusions:We conclude that the cost per QALY in this patient group is at an acceptable level by 4 years of age. Because the initial hospital care episode accounted for most of the costs, the cost per QALY will decrease with each additional follow-up year.

Impact of Very Preterm Birth on Health Care Costs at Five Years of Age

“…12 This is in accordance with previous studies, which showed that the use of health care resources declines with in- creasing age in individuals who were born preterm. 13,23 Thus, the first-year hospitalization costs and, in particular, the initial hospital stay compose the great majority of the total costs of care of very preterm infants.…”

“…11 Our study on the total hospitalization costs during the first 4 years of life for children who were born very preterm showed similar results: the initial hospital costs composed 79% of the total costs, and thereafter the costs decreased each year. 12 In addition, individuals with prematurity-associated morbidities used significantly more hospital resources during the first 4 years of life than those without these morbidities.…”

Economic costs associated with moderate and late preterm birth: a prospective population‐based study

“…6 A recent structured review summarising published evidence on the economic consequences of LMPT birth, 6 found that ten studies, published between 1980 and 2011, focused on economic costs during the infant's initial hospitalisation, [7][8][9][10][11][12][13][14][15][16] whereas 13 studies reported economic costs in some form following the infant's initial hospitalisation. 5,7,9,13,[17][18][19][20][21][22][23][24][25] None of the latter studies estimated the economic costs of LMPT birth from a societal perspective, however, with 11 studies limited to an estimation of hospital costs, 5,7,9,13,[19][20][21][22][23][24][25] and with two limited to an estimation of health and social services or public sector costs. 17,18 Moreover, these economic studies were either based on patient cohorts, recruited over a decade ago, 5,7,9,13,17,[19][20][21]<...>…”

“…5,7,9,13,[17][18][19][20][21][22][23][24][25] None of the latter studies estimated the economic costs of LMPT birth from a societal perspective, however, with 11 studies limited to an estimation of hospital costs, 5,7,9,13,[19][20][21][22][23][24][25] and with two limited to an estimation of health and social services or public sector costs. 17,18 Moreover, these economic studies were either based on patient cohorts, recruited over a decade ago, 5,7,9,13,17,[19][20][21][22][23][24] or hypothetical cohorts simulated within models. 18, 25 The aim of this study was to estimate the economic costs during the first 2 years of life associated with LMPT birth in the context of a recent prospective population-based study.…”

Costs and End-of-Life Care in the NICU: Lessons for the MICU?

“…What medical expenses are incurred after NICU discharge? That calculation depends strongly on two variables: (1) what was the infant's gestational age at birth? and (2) how much permanent morbidity remains after discharge?…”