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Incremental Cost of Prematurity by Week of Gestational Age
Eileen M Walsh1, Sherian X Li1, Libby K Black2
1Division of Research, Kaiser Permanente, Oakland, California.
Insights
Preterm infants born earlier in gestation incur significantly higher healthcare costs and utilization in their first year. Interventions to prevent preterm birth could lead to substantial cost savings.
Area of Science:
- Neonatal care
- Health economics
- Perinatal epidemiology
Background:
- Preterm birth is a significant concern in neonatal care.
- Understanding the economic impact of preterm birth is crucial for resource allocation.
Purpose of the Study:
- To compare healthcare costs and utilization from birth through one year between preterm and term infants, stratified by gestational age.
- To estimate potential cost savings from interventions preventing preterm delivery.
Main Methods:
- Cross-sectional study of infants born at ≥23 weeks gestational age (GA).
- Utilized internal neonatal registry and cost management databases (2000-2011).
- Adjusted models estimated cost differences by GA group.
Main Results:
- Infants born at 25-37 weeks GA had higher hospitalization costs and healthcare utilization in the first year compared to term infants.
- Each week decrease in GA (≤32 weeks) was associated with increased mortality and morbidity.
- Cost differences were most pronounced at lower gestations (≤30 weeks), but moderately preterm infants (31-36 weeks) also represented a substantial cost burden.
Conclusions:
- Findings support the economic benefits of interventions aimed at delaying or preventing preterm birth.
- Both very preterm and moderately preterm infants contribute significantly to healthcare costs.
- Targeted interventions can yield considerable cost savings in neonatal care.
Abstract:
Objective This study was aimed to compare health care costs and utilization at birth through 1 year, between preterm and term infants, by week of gestation. Methods A cross-sectional study of infants born at ≥ 23 weeks of gestational age (GA) at Kaiser Permanente Northern California facilities between 2000 and 2011, using outcomes data from an internal neonatal registry and cost estimates from an internal cost management database. Adjusted models yielded estimates for cost differences for each GA group. Results Infants born at 25 to 37 weeks incur significantly higher birth hospitalization costs and experience significantly more health care utilization during the initial year of life, increasing progressively for each decreasing week of gestation, when compared with term infants. Among all very preterm infants (≤ 32 weeks), each 1-week decrease in GA is associated with incrementally higher rates of mortality and major morbidities. Conclusion We provide estimates of potential cost savings that could be attributable to interventions that delay or prevent preterm delivery. Cost differences were most extreme at the lower range of gestation (≤ 30 weeks); however, infants born moderately preterm (31-36 weeks) also contribute substantially to the burden, as they represent a higher proportion of total births.
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