Preterm Birth and Total Health Care Use and Costs in the First 5 Years of Life: A Population-based Study
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Published on: January 12, 2018
Serena Yu1, Kei Lui2, Denzil G Fiebig3
1Faculty of Health, Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia.
Insights
Preterm birth significantly increases healthcare utilization and costs in the first five years of life. Infants born prematurely require more hospital days, specialist visits, and incur higher public healthcare expenses compared to term infants.
Area of Science:
- Public Health
- Pediatrics
- Health Economics
Background:
- Preterm birth is a significant global health concern with potential long-term consequences.
- Understanding the economic impact of preterm birth is crucial for healthcare resource allocation.
Purpose of the Study:
- To investigate the relationship between preterm birth and healthcare use and costs over the first five years of life.
- To compare healthcare utilization and costs among infants born at different gestational ages.
Main Methods:
- A population-based cohort study linked birth data with healthcare utilization records.
- Analysis included hospitalizations, primary and secondary care visits, and medication use.
- Linear regression models controlled for confounders like birth complications and maternal socioeconomic status.
Main Results:
- Preterm birth significantly increases healthcare use and costs up to five years post-birth.
- Infants born extremely preterm (<28 weeks) incurred 10.9-fold higher 5-year public healthcare costs compared to term infants.
- Preterm infants experienced more hospital days, specialist visits, and medication use across all preterm categories.
Conclusions:
- Preterm birth has a substantial and lasting economic impact on healthcare systems.
- Increased and sustained access to care is essential for preterm infants.
- Policymakers and clinicians must recognize these long-term needs for effective resource allocation and early interventions.
Objectives:
To investigate the relationship between preterm birth and hospital/out-of-hospital care and costs over the first 5 years of life.
Study Design:
Birth data from a population-based cohort of 631 532 infants born between 2007 and 2013 were linked probabilistically with data on hospitalizations, primary and secondary care, and the use of medications. We analyzed the distribution of health care use and public health care costs for infants who survived at least 5 years, comparing the outcomes of extremely preterm (<28 weeks of gestation), very preterm (28-32 weeks), moderate to late preterm (32-37 weeks), and term infants (at least 37 weeks). A linear regression model was used to investigate the effect of preterm birth on these outcomes, controlling for important confounders including pregnancy and birth complications, neonatal morbidity, survival, and maternal socioeconomic characteristics.
Results:
Preterm birth has a statistically significant and economically relevant effect on health care use and costs in the first 5 years of life. Compared with a term infant, preterm infants born at 32-36 weeks, 28-32 weeks, and <28 weeks of gestation had, respectively, an average of 7.0 (SE 0.06), 41.6 (0.18), and 68.7 (0.35) more hospital days; 3.1 (0.04), 11.0 (0.13), and 13.2 (0.25) more outpatient specialist physician visits; and 1.2-fold (<0.01), 6.8-fold (0.01), and 10.9-fold (0.02) higher 5-year public health care costs. Preterm infants also had statistically significantly higher levels of general practitioner visits and use of medications.
Conclusions:
Higher levels of accessible care are needed for preterm infants across health care settings and over sustained periods. As our understanding of the impact of preterm birth on long-term clinical outcomes continues to improve, clinicians and policymakers should develop an accurate recognition of these needs to enable appropriate resource allocation toward research priorities and early intervention strategies.
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