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Hospital costs and quality of life during 4 years after very preterm birth
Emmi Korvenranta1, Miika Linna, Liisi Rautava
1Department of Pediatrics, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland. emmi.korvenranta@utu.fi
Insights
The cost per quality-adjusted life-year (QALY) for very preterm children by age 4 is acceptable, despite higher initial hospital costs. Costs decrease over time as initial hospital stays represent the majority of expenses.
Area of Science:
- Medical Economics
- Pediatric Health Outcomes
- Public Health Policy
Background:
- Healthcare costs for preterm infants are a significant concern.
- Understanding long-term cost-effectiveness is crucial for resource allocation.
- Gestational age and prematurity-related morbidities influence healthcare utilization.
Purpose of the Study:
- To assess the impact of gestational age and prematurity morbidities on hospital costs.
- To determine the cost per quality-adjusted life-year (QALY) for very preterm children up to 4 years of age.
- To evaluate the long-term economic implications of preterm birth.
Main Methods:
- A population-based study utilizing national register data and parental questionnaires in Finland.
- Inclusion of 2064 very preterm children and 200,609 full-term controls born between 2000-2003.
- Analysis of hospital care costs and cost per QALY at 4 years, stratified by gestational age and morbidities.
Main Results:
- The cost per QALY for full-term controls was €1181, compared to €19,245 for very preterm children.
- Cost per QALY increased with decreasing gestational age and rose significantly with multiple morbidities (€14,368 vs. €36,110).
- Initial hospital stay accounted for 79.5% of total 4-year hospital costs in very preterm infants.
Conclusions:
- The cost per QALY for very preterm children is considered acceptable by 4 years of age.
- Given that initial hospital care dominates costs, the cost per QALY is expected to decrease with further follow-up.
- These findings support the economic viability of intensive initial care for preterm infants.
Objective:
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 <32 weeks or birth weight <1501 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 full-term controls (in 2008 currency) was euro1181 (US$1736). In very preterm children, the average cost per QALY was euro19 245 ($28 290), ranging from euro11 824 to euro54 324 ($17 381 to $79 856) and increasing with decreasing gestational age. The cost per QALY was euro14 368 ($21 121) for those without any of the studied morbidities and euro36 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.
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