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Costs and health utilities associated with extremely preterm birth: evidence from the EPICure study
Stavros Petrou1, Giselle Abangma, Samantha Johnson
1National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Old Road, Oxford, UK. stavros.petrou@npeu.ox.ac.uk
Insights
Extremely preterm birth significantly increases public sector costs and reduces health utility scores by age 11. These findings highlight the long-term economic and health impacts of preterm birth.
Area of Science:
- Public health
- Health economics
- Neonatal care outcomes
Background:
- Extremely preterm birth (born < 26 weeks gestation) poses significant challenges.
- Long-term cost and health utility impacts of extremely preterm birth are not fully understood.
- The EPICure study provides a unique whole-population dataset for this analysis.
Purpose of the Study:
- To estimate the public sector costs associated with extremely preterm birth at approximately 11 years of age.
- To assess the health utility scores of extremely preterm children compared to their term-born peers.
- To inform economic evaluations of interventions for preterm birth.
Main Methods:
- Utilized data from the EPICure study, comparing extremely preterm survivors (20-25 weeks gestation) with matched term-born classmates.
- Estimated public sector costs using generalized linear regression on service utilization and unit costs.
- Assessed health utilities using the Health Utilities Index Mark III (HUI-III) and tobit regressions for gestational age effects.
Main Results:
- Extremely preterm birth resulted in significantly higher mean public sector costs (2477 UK pounds difference) at age 11.
- Suboptimal function across all eight HUI-III attributes was more prevalent in extremely preterm children.
- Mean HUI-III utility scores were significantly lower for extremely preterm children (0.789) compared to term-born classmates (0.956).
Conclusions:
- Extremely preterm birth leads to substantial long-term public sector costs and reduced health-related quality of life.
- Gestational age at birth significantly impacts both costs and health utilities.
- Findings support the need for economic evaluations of interventions targeting preterm birth prevention and management.
Objective:
To estimate costs and health utilities associated with extremely preterm birth at approximately 11 years of age using evidence from a whole population study (the EPICure study).
Methods:
The study population comprised surviving children born at 20 through 25 completed weeks of gestation in all 276 maternity units in the United Kingdom and Republic of Ireland from March through December 1995 and a control group of classmates born at full term, matched for age, sex, and ethnic group. Estimates of utilization of health, social, and education services were combined with unit costs derived from primary and secondary sources. Generalized liner regression was used to estimate the impact of extremely preterm birth on public sector costs during the 11th year of life. Suboptimal levels of function for each of the eight attributes of the Health Utilities Index Mark III (cognition, vision, hearing, speech, ambulation, dexterity, emotion, and pain) and multiplicative multi-attribute utility scores were compared between the extremely preterm children and their classmates. Tobit regressions were performed to explore the effects of gestational age at birth on the Health Utilities Index Mark III multiattribute utility score.
Results:
Mean (standard deviation [SD]) public sector costs over the 12-month period were 6484 UK pounds (5548 pounds) for the combined extremely preterm group and 4007 pounds (2537 pounds) for their classmates, generating a mean cost difference of 2477 UK pounds(bootstrap 95% confidence interval [CI] 1605 pounds, 3360 pounds) that was statistically significant (P < 0.001). The generalized linear models revealed that compared to birth at term, birth at < or =23 completed weeks, 24(+0)-24(+6) weeks and 25(+0)-25(+6) weeks gestation increased public sector costs by an average of 2417 UK pounds (95% CI 60 pounds, 4774 pounds; P = 0.044), 1528 UK pounds (95% CI 129 pounds, 2927 pounds; P = 0.032) and 1501 UK pounds (95% CI 428 pounds, 2574 pounds; P = 0.006), respectively. In all eight attributes of the Health Utilities Index Mark III, there were significantly higher proportions of suboptimal levels of function among the extremely preterm children (P < or = 0.05). The mean (SD) multiattribute utility score for the extremely preterm children as a cohort was 0.789 (0.264), compared to 0.956 (0.102) for the classmates born at term, a mean difference in utility score of 0.167 (95% CI 0.124, 0.209) that was statistically significant (P < 0.001). The Tobit regressions revealed that, compared to birth at term, birth at < or =23 completed weeks, 24(+0)-24(+6) weeks and 25(+0)-25(+6) weeks gestation reduced the Health Utilities Index Mark III multi-attribute utility score by an average of 0.312 (95% CI 0.169, 0.455; P < 0.001), 0.337 (95% CI 0.235, 0.439; P < 0.001) and 0.243 (95% CI 0.159, 0.327; P < 0.001), respectively.
Conclusions:
The results of this study should be used to inform the development of future economic evaluations of interventions aimed at preventing extremely preterm birth or alleviating its effects.
