Hospitalization charges for extremely preterm infants: a ten-year analysis in Shanghai, China
Zhicheng Zhu1, Jin Wang1, Chao Chen1
1Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
Insights
The initial hospitalization for extremely preterm infants in China incurs a significant economic burden, costing a median of $20,770.70. Rising medical charges over time highlight the need for financial planning and policy adjustments for neonatal intensive care.
Area of Science:
- Neonatal Medicine
- Health Economics
- Public Health
Background:
- Extreme prematurity poses a global economic challenge, particularly in developing nations with strained healthcare systems.
- Understanding the initial hospitalization costs for extremely preterm infants is crucial for financial planning and resource allocation.
Purpose of the Study:
- To estimate the initial hospitalization charges for extremely preterm infants in China over the past decade.
- To analyze factors influencing these costs, including gestational age, survival status, and major morbidities.
Main Methods:
- Retrospective study of 441 extremely preterm infants (<28 weeks gestation) discharged between 2010-2019.
- Data collected from electronic medical records at a tertiary neonatal intensive care unit in Shanghai.
- Subgroup analyses examined variations in charges and length of stay by key infant and treatment characteristics.
Main Results:
- Median total hospitalization charge was $20,770.70, with a median stay of 70 days.
- Costs decreased with increasing gestational age but showed an upward trend over time.
- Infants with necrotizing enterocolitis, bronchopulmonary dysplasia, and sepsis incurred significantly higher charges.
- Treatment costs constituted the largest proportion (31.3%) of total expenses.
Conclusions:
- The initial hospitalization for extremely preterm infants represents a substantial economic burden in China.
- Findings underscore the importance of considering these economic factors in perinatal consultations, insurance policies, and clinical decision-making.
- Limitations include potential lack of generalizability and exclusion of long-term medical charges.
Objectives:
Extreme prematurity exerts a substantial economic burden on families and societies worldwide, especially in developing countries with limited healthcare resources. This study aimed to estimate initial hospitalization charges after extremely preterm birth in China over the previous decade.
Methods:
A retrospective study was conducted in the largest tertiary neonatal intensive care unit in Shanghai, China, including 441 extremely preterm infants (gestational age <28 weeks) discharged between 2010 and 2019. Hospitalization data and medical charges were obtained from electronic inpatient medical records. Subgroup analysis was conducted to examine how the charges and length of stay varied by gestational age, discharge year, survival status, and major morbidities.
Results:
The median total hospitalization charge was $20,770.70 with a median length of stay of 70.0 days. Total and daily charges declined as gestational age increased. A rising trend was found over time for overall and daily medical charges. Compared with decedents, survivors had a longer length of stay and higher total hospitalization charges, but their charge per day was lower. Total hospitalization charges were significantly higher in infants with necrotizing enterocolitis (Stage II-III), bronchopulmonary dysplasia, and sepsis when compared with neonates of the same gestational age without these co-morbidities. Charges for treatments accounted for the highest proportion (31.3%).
Limitations:
Local statistics collected retrospectively might limit generalizability to other regions. Long-term medical charges were not reported.
Conclusion:
Economic burden of the initial hospitalization for extremely preterm infants was substantial in China. Such economic factors should be fully taken into account for perinatal consultations, medical insurance policy-making, and clinical decisions.
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