Hypothermia for perinatal asphyxia: trial-based resource use and costs at 6-7 years
Oliver Rivero-Arias1, Oya Eddama1, Denis Azzopardi2,3
1Nuffield Department of Population Health, National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK.
Insights
Hypothermic neural rescue for perinatal asphyxia survivors showed lower healthcare costs at 6-7 years compared to standard care. This neuroprotective intervention may offer long-term economic benefits, complementing clinical findings.
Area of Science:
- Neonatal care
- Clinical economics
- Neuroprotection
Background:
- The Total Body Hypothermia for Neonatal Encephalopathy (TOBY) trial investigated therapeutic hypothermia for neonatal encephalopathy.
- This study reports on the long-term healthcare costs of survivors from the TOBY trial.
- The trial is registered under NCT01092637.
Purpose of the Study:
- To evaluate the impact of hypothermic neural rescue on healthcare costs in children aged 6-7 years who experienced perinatal asphyxia.
- To determine the correlation between overall disability levels and healthcare expenditures in these survivors.
- To provide economic insights for healthcare professionals and policymakers regarding perinatal asphyxia management.
Main Methods:
- A 6-7 year follow-up of surviving children from the TOBY trial.
- A community-based study utilizing parental questionnaires to gather data on healthcare resource utilization.
- 130 UK children (63 control, 67 hypothermia group) participated.
Main Results:
- Mean healthcare costs at 6-7 years were £1543 (hypothermia group) versus £2549 (control group), indicating a potential saving of -£1005 with hypothermia.
- Higher disability levels correlated with increased healthcare costs.
- Increased parental employment was observed in the hypothermia group (64% vs 47%).
- Results were sensitive to extreme values, particularly the care needs of two severely affected children in the control group.
Conclusions:
- While not statistically significant, healthcare cost trends favored moderate hypothermia, aligning with the TOBY Children study's clinical outcomes.
- The relationship between costs and disability levels provides valuable data for economic evaluations of perinatal asphyxia interventions.
- Therapeutic hypothermia may offer long-term economic advantages, warranting consideration in clinical and policy decisions.
Objective:
To assess the impact of hypothermic neural rescue for perinatal asphyxia at birth on healthcare costs of survivors aged 6-7 years, and to quantify the relationship between costs and overall disability levels.
Design:
6-7 years follow-up of surviving children from the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) trial.
Setting:
Community study including a single parental questionnaire to collect information on children's healthcare resource use.
Patients:
130 UK children (63 in the control group, 67 in the hypothermia group) whose parents consented and returned the questionnaire.
Interventions:
Intensive care with cooling of the body to 33.5°C for 72 hours or intensive care alone.
Main Outcome Measures:
Healthcare resource usage and costs over the preceding 6 months.
Results:
At 6-7 years, mean (SE) healthcare costs per child were £1543 (£361) in the hypothermia group and £2549 (£812) in the control group, giving a saving of -£1005 (95% CI -£2734 to £724). Greater levels of overall disability were associated with progressively higher costs, and more parents in the hypothermia group were employed (64% vs 47%). Results were sensitive to outlying observations.
Conclusions:
Cost results although not significant favoured moderate hypothermia and so complement the clinical results of the TOBY Children study. Estimates were however sensitive to the care requirements of two seriously ill children in the control group. A quantification of the relationship between costs and levels of disability experienced will be useful to healthcare professionals, policy makers and health economists contemplating the long-term economic consequences of perinatal asphyxia and hypothermic neural rescue.
Trial Registration Number:
This study reports on the follow-up of the TOBY clinical trial: ClinicalTrials. gov number NCT01092637.
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