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Predicting costs and outcomes of neonatal intensive care for very low birthweight infants
R C Stevenson1, P O Pharoah, R W Cooke
1Department of Economics, Liverpool University.
Insights
Birthweight alone poorly predicts healthcare costs for infants. Clinical factors are more effective in estimating costs and quality-adjusted life years for disabled children, highlighting the importance of clinical judgment.
Area of Science:
- Neonatal care
- Health economics
- Disability studies
Background:
- Infants born with low birthweight (<1,500g) require extensive medical care.
- Assessing the long-term costs and outcomes for these vulnerable infants is crucial for resource allocation.
Purpose of the Study:
- To evaluate the predictive power of birthweight versus clinical factors on healthcare costs and quality-adjusted life years (QALYs) in low birthweight infants.
- To inform resource allocation strategies for disabled children.
Main Methods:
- A cohort of infants (<1,500g) born in 1980-1981 was followed to age four.
- Disabilities were classified (mild, moderate, severe) to calculate QALYs.
- Healthcare costs (hospitalization to age four, lifetime care) were assessed.
- Regression analysis was used to determine the predictive power of birthweight and clinical factors on costs and QALYs.
Main Results:
- Birthweight alone showed poor predictive power for healthcare costs.
- Clinical factors explained up to 60% of initial hospital costs for survivors.
- Clinical factors explained up to 30% of lifetime costs and QALYs.
Conclusions:
- Relying solely on birthweight for resource allocation is flawed.
- Clinical assessment is vital for accurately estimating costs and QALYs for disabled children.
- Clinical discretion improves resource allocation for high-risk infants.
Abstract:
A geographically determined cohort of all infants of less than 1,500 g born in 1980 and 1981 were clinically followed up to age four to determine their disabilities which were classified as mild, moderate or severe. A quality adjustment coefficient, determined by the severity of the disability, was used to calculate the number of quality adjusted lives produced. The total cost of care for these children was assessed as the sum of hospital costs to age four (which were specifically determined) and an estimate of the life-time costs of care of disabled children from information provided by the Education and Social Service departments. A very poor predictive power of birthweight with cost was obtained with the ungrouped birthweight data, whereas clinical factors explained up to 60% of the variance of the initial hospital costs for survivors and up to 30% of the variance of life-time costs and the cost of quality adjusted lives produced. Rules for the allocation of resources based on discrimination by birthweight are flawed but the application of clinical discretion is important.