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Cost of neonatal intensive care for extremely preterm infants in Canada
Asaph Rolnitsky1, Sharon L Unger1, David R Urbach1
1University of Toronto, Toronto, Ontario, Canada.
Insights
Neonatal intensive care for extremely preterm infants is costly. Total costs for surviving 23-25-week infants were similar, emphasizing the need for a dedicated funding strategy for this vulnerable population.
Area of Science:
- Neonatal Medicine
- Health Economics
- Public Health Policy
Background:
- Neonatal intensive care is a significant financial burden, often involving prolonged support for extremely preterm infants.
- The costs associated with intensive care for infants born at the threshold of viability are a critical concern for healthcare providers and policymakers.
- Understanding these costs is essential for resource allocation and financial planning in neonatal healthcare.
Purpose of the Study:
- To analyze the total cost and length of hospital stay for premature infants born between 23 and 28 weeks of gestation.
- To compare the total and daily costs of neonatal intensive care for infants born at 23-25 weeks gestation.
- To provide data that can inform funding strategies for the care of extremely preterm infants.
Main Methods:
- Utilized Canadian national administrative database data from 2011-2015.
- Analyzed cost and length of stay from a public payor perspective for 23-28-week premature infants.
- Employed non-parametric tests, correlation tests, and generalized linear models for cost analysis, adjusting for survival and length of stay.
Main Results:
- Analyzed cost records for 6,932 infants, with a median hospital stay of 61 days for survivors beyond 3 days.
- Median total cost for infants surviving the first 3 days was $91,137.
- No significant difference in median total costs was found among surviving 23-25-week infants ($147,835, $154,736, and $130,317, respectively).
Conclusions:
- Neonatal intensive care incurs substantial total and daily costs.
- The total costs for surviving infants born at 23-25 weeks gestation did not differ significantly.
- These findings underscore the necessity of developing a robust funding strategy to support the routine care of extremely preterm infants.
Background:
Neonatal intensive care is expensive and prolonged. Extremely preterm infants are routinely supported. The costs for this practice at the age of borderline viability are of interest to clinicians and policymakers.
Methods:
We analyzed data from the Canadian national administrative database on total cost and length of hospital care from a public payor perspective for 23-28-week premature infants from 2011 to 2015. We also compared total and daily costs for 23-25-week newborns. Each comparison evaluated the total cohort and infants who lived more than 3 days. We used non-parametric tests, correlation tests, and generalized linear models for cost difference analysis, adjusting for survival, length of stay, and year.
Results:
We analyzed 6,932 infants' cost records. For all infants, median length of hospital stay was 41 days (IQR, 1-77 days). For infants who survived the first 3 days, median length of stay was 61 days (IQR, 34-90 days). The median total cost was $66,669 (IQR, $4,920-$125,550). For infants who survived the first 3 days, median total cost was $91,137 (IQR, $56,596-$188,757). For infants who survived the first 3 days, median total costs were $147,835 (IQR, $44,711-$233,847) for 23-week infants, $154,736 (IQR, $61,160-$248,290) for 24-week infants, and $130,317 (IQR, $79,737-$229,058) for 25-week infants. These amounts did not differ (P>0.7).
Conclusions:
Total and daily costs of neonatal intensive care are high. Total cost was not different between surviving 23-25-week infants. These findings highlight the need for a funding strategy for the routine support of these fragile infants.
