Economic considerations at the threshold of viability

Area of Science:

• Neonatology
• Health Economics
• Perinatal Medicine

Background:

• Neonatal intensive care for infants born at 22-24 weeks gestation has increased over the last 30 years.
• Significant variability exists in outcomes for these infants across different medical centers, often linked to management strategies.
• Concerns exist regarding the rising costs associated with the care of survivors.

Purpose of the Study:

• To review the direct medical, direct non-medical, and indirect costs associated with periviable infant care.
• To analyze the cost-effectiveness of neonatal intensive care and specific therapies for extremely preterm infants.
• To identify limitations in current data and discuss strategies to address knowledge gaps in the economic impact of periviable infant care.

Main Methods:

• Literature review of direct medical, non-medical, and indirect costs.
• Analysis of cost-effectiveness data for neonatal intensive care and therapies.
• Discussion of ethical considerations in periviable infant decision-making.

Main Results:

• Outcomes for infants born at 22-24 weeks are highly variable between centers.
• Increased intervention frequency raises concerns about concurrent increases in care costs for survivors.
• Data on the economic impact of periviable infant care has limitations.

Conclusions:

• Understanding the economic impact of caring for periviable infants is crucial.
• Further research is needed to address data gaps regarding the costs and cost-effectiveness of interventions.
• Ethical dilemmas are intertwined with economic considerations in periviable infant care decisions.