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Rationing potentially inappropriate treatment in newborn intensive care in developed countries

Dominic Wilkinson1, Stavros Petrou2, Julian Savulescu3

  • 1Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; John Radcliffe Hospital, Oxford, UK.

Seminars in Fetal & Neonatal Medicine
|November 5, 2017
PubMed

Insights

Newborn intensive care may be cost-effective, even for premature infants with low survival chances or poor quality of life. Cost-effectiveness analysis challenges assumptions about limiting intensive care for newborns.

Area of Science:

  • Medical Ethics
  • Health Economics
  • Neonatal Medicine

Background:

  • Parental requests for potentially inappropriate or futile treatments in neonatal intensive care are common.
  • Treatment decisions are influenced by cost-effectiveness, with some health systems using funding thresholds.
  • Assessing the value of intensive care for newborns requires careful consideration of survival, quality of life, and prematurity.

Purpose of the Study:

  • To explore the application of cost-effectiveness thresholds in newborn intensive care.
  • To analyze criteria for limiting intensive care, including survival probability, treatment duration, quality of life, and prematurity.
  • To evaluate the cost-effectiveness of intensive care for critically ill newborns.

Main Methods:

  • Analysis of cost-effectiveness thresholds in public health systems.
  • Application of these thresholds to specific scenarios in newborn intensive care.
  • Evaluation of economic value across varying infant prognoses and gestational ages.

Main Results:

  • Newborn intensive care can be cost-effective even with a low probability of survival.
  • Cost-effectiveness may hold for infants with poor predicted quality of life.
  • Extended treatment durations and care for the most premature infants can also be cost-effective.

Conclusions:

  • The study challenges conventional views on limiting newborn intensive care based solely on survival rates or predicted quality of life.
  • Cost-effectiveness analysis suggests that intensive care for newborns, including premature infants, may be more justifiable than often assumed.
  • Ethical and economic considerations in neonatal care require nuanced evaluation beyond simple thresholds.

Keywords:
Cost-benefit analysisIntensive careMedical ethicsMedical futilityWithholding treatment

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