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Cost analysis of neonatal tele-homecare for preterm infants compared to hospital-based care
Maja K Rasmussen1, Jane Clemensen1,2,3, Gitte Zachariassen2,3
1Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Insights
Neonatal tele-homecare (NTH) is a cost-effective alternative to regular hospital care for preterm infants. This telehealth model significantly reduces healthcare expenses, particularly for infants born at or under 32 weeks gestation.
Area of Science:
- Neonatal care
- Health economics
- Telehealth applications
Background:
- Neonatal homecare (NH) offers parents the option of bringing stable preterm infants home for feeding support from nurses.
- Hospital-based home visits present logistical challenges in large regions, making regular neonatal hospital care the standard in Denmark.
- Neonatal tele-homecare (NTH) was developed as a telehealth alternative to overcome challenges associated with traditional NH home visits.
Purpose of the Study:
- To assess the costs of neonatal tele-homecare (NTH) in comparison to regular neonatal hospital care.
- To evaluate NTH from a health service perspective, focusing on resource utilization and overall expenses.
Main Methods:
- An observational study in Denmark (Nov 2015-Dec 2016) compared NTH with a historical cohort receiving standard neonatal intensive care unit (NICU) care.
- The study included 96 infants in the NTH group and 278 in the control group, categorized by gestational age (at/under 32 weeks vs. over 32 weeks).
- Outcomes measured included resource utilization, in-NICU bed days, re-admissions, and total average costs per infant from birth to discharge.
Main Results:
- NTH resource utilization averaged €695 per infant.
- Total average costs per infant were €12,200 (at/under 32 weeks) and €4200 (over 32 weeks) for NTH.
- Control group costs were €14,300 (at/under 32 weeks) and €4400 (over 32 weeks), with a statistically significant cost difference favoring NTH for infants under 32 weeks (p < 0.001).
Conclusions:
- Neonatal tele-homecare (NTH) is a less costly model of care compared to regular hospital care for preterm infants.
- The cost savings are particularly pronounced for infants born at or under 32 weeks gestational age.
- NTH is presented as a clinically effective and economically advantageous care model for preterm infants and their families.
Introduction:
Neonatal homecare (NH) can be used to provide parents the opportunity of bringing cardiopulmonary-stable preterm infants home for tube feeding and the establishment of breastfeeding supported by neonatal nurses visiting the home. However, home visits can be challenging for hospitals covering large regions, and, therefore, regular neonatal hospital care has remained the first choice in Denmark. As an alternative to home visits, telehealth may be used to deliver NH. Thus, neonatal tele-homecare (NTH) was developed. Positive infant outcomes and the optimization of family-centred care have been described, but the costs of telehealth in the context of NH remain unknown. This study aims to assess the costs of NTH compared to regular neonatal hospital care, from the health service perspective.
Methods:
The cost analysis was based on an observational study of NTH in Denmark (run from November 2015 to December 2016) and followed the Consolidated Health Economic Evaluation Reporting Standards. The intervention group were the families of preterm infants receiving NTH (n = 96). The control group comprised a historic cohort of families with preterm infants, receiving standard care in the neonatal intensive care unit (NICU) (n = 278). NTH infants and the historical group were categorized according to gestational age at birth at/under and over 32 weeks. The outcomes were NTH resource utilization, in-NICU hospital bed days, re-admissions and total costs on average per infant. The time horizon was from birth to discharge.
Results:
The costs of NTH resource utilization were, on average, €695 per infant, and the total costs per infant, on average, were €12,200 and €4200 for infants at/under and over 32 weeks, respectively. The corresponding costs of the control group were €14,300 and €4400. The difference in total costs showed statistical significance for the group of infants under 32 weeks (p < 0.001).
Discussion:
The cost analysis showed that NTH was less costly compared to regular hospital care, especially for infants born with gestational age at/under 32 weeks. NTH is an appropriate model of care for preterm infants and their families, is clinically effective and less expensive than similar services delivered in the hospital.
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