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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
Preterm birth: a cost benefit analysis
1Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510, USA.
Insights
Optimizing preterm infant care through cost-effective therapies like antenatal steroids and surfactant administration significantly improves survival rates and reduces long-term neurological disabilities. These interventions offer substantial cost savings per survivor.
Area of Science:
- Neonatal Medicine
- Perinatal Care
- Health Economics
Background:
- Advances in neonatal intensive care have improved survival for preterm and very low birth weight (VLBW) infants.
- Certain interventions reduce long-term sequelae, enhancing cost-effectiveness.
- Protecting the preterm brain is a critical focus in neonatal care.
Purpose of the Study:
- To review the cost-effectiveness of therapies aimed at protecting the preterm brain.
- To evaluate the economic impact of interventions improving outcomes for preterm infants.
Main Methods:
- Review of existing literature on prenatal and perinatal treatments for preterm infants.
- Analysis of cost-effectiveness data for various neuroprotective therapies.
- Comparison of outcomes and costs associated with different treatment strategies.
Main Results:
- Birth in a NICU setting improves survival and reduces severe neurological disability.
- Antenatal steroids increase survival, decrease major morbidities (e.g., IVH, NEC, RDS), and lower costs per survivor.
- Prophylactic surfactant and indomethacin reduce treatment costs and specific complications like RDS and intraventricular hemorrhage.
Conclusions:
- Targeted prenatal and perinatal therapies are cost-effective for improving preterm infant survival and reducing long-term disabilities.
- Antenatal steroids, surfactant, and prophylactic indomethacin are key cost-saving interventions.
- Careful timing of postnatal dexamethasone is crucial to avoid adverse neurological outcomes.
Abstract:
Advances in prenatal and perinatal treatment of preterm and VLBW infants have dramatically increased the survival rate of these infants. Some interventions decrease long term sequelae associated with preterm birth, making them more cost-effective than other treatments. This paper reviews the cost-effectiveness of therapies targeted to protect the preterm brain. Birth in a center with a NICU improves survival and decreases the rate of severe neurologic disability. Administration of antenatal steroids increases survival and decreases rates of periventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, respiratory distress syndrome, and severe disability. Administration of antenatal steroids decreases costs per additional survivor. Addition of surfactant to the treatment of PT infants has also decreased treatment costs. Administration of surfactant is beneficial for symptomatic RDS but recognizes a greater benefit when given to infants younger than 30 weeks gestation prophylactically. Treatment with prophylactic indomethacin decreases the rate of intraventricular hemorrhage and results in cost savings in survivors. Postnatal administration of dexamethasone can lead to severe disability when administered before 7 to 10 days of life. Postnatal dexamethasone does not increase survival or decrease rates of chronic lung disease.
