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Published on: February 18, 2012
PERFECT preterm infant study
Liisa Lehtonen1, Liisi Rautava, Emmi Korvenranta
1Department of Paediatrics, Turku University Hospital, Turku, Finland. liisa.lehtonen@utu.fi
Insights
Birth in a level III hospital improves survival for very low gestational age (VLGA) and very low birth weight (VLBW) infants. Care for these infants is cost-effective by four years, with reduced morbidities enhancing value.
Area of Science:
- Neonatalogy
- Health Economics
- Perinatal Medicine
Background:
- The study investigated the impact of hospital level and birth timing on outcomes for very low gestational age (VLGA) and very low birth weight (VLBW) infants.
- This research is a sub-study of the PERFECT (Performance, Effectiveness and Costs of Treatment episodes) study.
Purpose of the Study:
- To analyze the effects of birth hospital level and time of birth on mortality and morbidity in VLGA/VLBW infants.
- To assess the cost-effectiveness of care for VLGA/VLBW infants.
Main Methods:
- Inclusion of all infants born below 32 weeks gestation or weighing 1501 g in Finland between 2000-2007.
- Utilization of different cohorts based on the time point of assessment.
Main Results:
- One-year mortality was higher for VLBW/VLGA infants born in level II compared to level III hospitals.
- Mortality was also higher for infants born during out-of-office hours in level II hospitals versus office hours in level III hospitals.
- The average cost per quality-adjusted life year was €19,245 by four years of age, with higher costs associated with long-term morbidities.
Conclusions:
- Birth in a level III hospital is associated with improved survival rates for VLGA/VLBW infants.
- Findings suggest potential issues with overnight care capacity in smaller (level II) hospitals.
- Care for VLGA/VLBW infants is cost-effective by four years of age, and reducing long-term morbidities can further improve cost-effectiveness.
Introduction:
This article summarizes the main findings of the preterm infant sub-study of the Performance, Effectiveness and Costs of Treatment episodes (PERFECT) study. We studied effects of birth hospital level and time of birth on mortality and morbidity and cost-effectiveness of care of very low gestational age (VLGA)/very low birth weight (VLBW) infants.
Material And Methods:
The study included all infants born below 32 weeks or 1501 g in Finland in 2000-2007. Different cohorts were used depending on the time point.
Results:
The one-year mortality of live-born VLBW/VLGA infants was higher if born in level II versus level III hospitals, or if born during out-of-office hours in level II versus office hours in level III hospitals. Two out of three VLGA/VLBW subjects did not have any of the prematurity-related morbidities studied. The average cost of quality-adjusted life years was €19,245 by four years of age; the cost was higher in VLGA/VLBW infants with long-term morbidities.
Discussion:
Birth in a level III hospital improved survival of VLGA/VLBW infants. Results suggest inadequate overnight competence in small hospitals. Despite high initial costs, care of VLGA/VLBW infants was already cost-effective by four years of age. Cost-effectiveness can be improved by reducing long-term morbidities.
