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The economic burden of prematurity in Canada
Karissa M Johnston, Katherine Gooch, Ellen Korol
1Epidemiology, Oxford Outcomes Ltd,, Vancouver, Canada. adrian.levy@dal.ca.
Insights
Preterm birth significantly impacts Canadian infants, with moderate preterm births posing the greatest national burden due to high costs and population size. Early preterm infants face the highest individual burden, while late preterm infants represent the largest population group.
Area of Science:
- Public Health
- Pediatrics
- Health Economics
Background:
- Preterm birth is a leading cause of infant morbidity and mortality globally.
- The burden of preterm birth varies by gestational age, with early and moderate preterm infants facing higher risks.
- Late preterm infants, though less vulnerable individually, represent a substantial population, contributing significantly to societal burden.
Purpose of the Study:
- To quantify the multifaceted burden of preterm birth in Canada.
- To analyze resource utilization, direct medical costs, parental expenses, educational costs, and mortality for early, moderate, and late preterm infants.
- To adapt a UK-based decision model to the Canadian context using Québec administrative data.
Main Methods:
- Utilized a validated decision model adapted for the Canadian healthcare landscape.
- Employed population-based administrative data from Québec for analysis.
- Characterized the burden across different categories: resource use, costs (medical, out-of-pocket, education), and mortality.
Main Results:
- Two-year survival rates were 56.0% (early), 92.8% (moderate), and 98.4% (late preterm).
- Ten-year costs per infant were $67,467 (early), $52,796 (moderate), and $10,010 (late preterm).
- Total national costs reached $587.1 million, with moderate preterm infants accounting for the largest share ($255.6 million) due to combined cost and population size.
Conclusions:
- Preterm birth imposes substantial and long-lasting morbidity, mortality, healthcare utilization, and economic costs in Canada.
- Moderate preterm infants present the greatest national burden, while early preterm infants incur the highest individual costs.
- Healthcare costs and resource utilization extend beyond the neonatal period into childhood, highlighting the need for sustained support.
Background:
Preterm birth is a major risk factor for morbidity and mortality among infants worldwide, and imposes considerable burden on health, education and social services, as well as on families and caregivers. Morbidity and mortality resulting from preterm birth is highest among early (< 28 weeks gestational age) and moderate (28-32 weeks) preterm infants, relative to late preterm infants (33-36 weeks). However, substantial societal burden is associated with late prematurity due to the larger number of late preterm infants relative to early and moderate preterm infants.
Methods:
The aim in this study was to characterize the burden of premature birth in Canada for early, moderate, and late premature infants, including resource utilization, direct medical costs, parental out-of-pocket costs, education costs, and mortality, using a validated and published decision model from the UK, and adapting it to a Canadian setting based on analysis of administrative, population-based data from Québec.
Results:
Two-year survival was estimated at 56.0% for early preterm infants, 92.8% for moderate preterm infants, and 98.4% for late preterm infants. Per infant resource utilization consistently decreased with age. For moderately preterm infants, hospital days ranged from 1.6 at age two to 0.09 at age ten. Cost per infant over the first ten years of life was estimated to be $67,467 for early preterm infants, $52,796 for moderate preterm infants, and $10,010 for late preterm infants. Based on population sizes this corresponds to total national costs of $123.3 million for early preterm infants, $255.6 million for moderate preterm infants, $208.2 million for late preterm infants, and $587.1 million for all infants.
Conclusion:
Premature birth results in significant infant morbidity, mortality, healthcare utilization and costs in Canada. A comprehensive decision-model based on analysis of a Canadian population-based administrative data source suggested that the greatest national-level burden is associated with moderate preterm infants due to both a large cost per infant and population size while the highest individual-level burden is in early preterm infants and the largest total population size is in late preterm infants. Although the highest medical costs are incurred during the neonatal period, greater resource utilization and costs extend into childhood.
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