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Optimal obstetric care reduces neonatal healthcare costs compared with substandard care in hypoxic-ischemic
Mikko Tarvonen1, Tommi Riehunkangas2, Ville Tuppurainen3
1Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Background:
Neonatal hypoxic-ischemic encephalopathy remains a leading cause of neonatal death and lifelong neurological impairment, imposing substantial economic burdens on affected families and healthcare system. While prior research has examined the cost-effectiveness of therapeutic hypothermia and hospital resource utilization, the economic impact of preventive strategies reflecting real-world variations in obstetric care has not been studied.
Objective:
To compare the true cost of optimal vs substandard obstetric care in cases with and without neonatal hypoxic-ischemic encephalopathy.
Study Design:
This retrospective economic analysis included a 20-year (2005-2024) cohort of 317,126 term singleton deliveries with 314 cases of hypoxic-ischemic encephalopathy across 7 hospitals within the Helsinki University Hospital district, Finland. Optimal care was defined as timely delivery in response to nonreassuring fetal status, while substandard care referred delayed or missed responses. The primary outcome was the direct neonatal healthcare cost from birth to hospital discharge. Secondary outcomes included the relative risk of hypoxic-ischemic encephalopathy and the incremental cost per disability-free life year gained by age 4. Costs across 4 groups (optimal or substandard care, with or without hypoxic-ischemic encephalopathy) were compared using generalized linear models. The study was powered at 90% to detect a ≥$1448 mean cost difference.
Results:
The mean cost per newborn was lower in the optimal care group compared with the substandard care group, irrespective of hypoxic-ischemic encephalopathy occurrence ($1269 vs $2807; mean difference $1537 [+121%]; 95% confidence interval, $662-$2413; P<.001). The largest disparity was between neonatal hypoxic-ischemic encephalopathy cases after substandard care and cases without hypoxic-ischemic encephalopathy under optimal care ($28,315 vs $988; mean difference $27,327 [+2766%]; 95% confidence interval, $19,721-$34,779; P<.001). Optimal care yielded a 4-year disability-free life year gain of 0.06 per newborn (95% confidence interval, 0.05-0.07), with an incremental cost of $25,617 (95% confidence interval, $40,221 to $11,013; P<.001) per disability-free life year gained. The incidence of hypoxic-ischemic encephalopathy was 1.53% (95% confidence interval, 1.21-1.93) in the substandard care group, representing a 20-fold increase in risk (relative risk, 19.60; 95% confidence interval, 15.00-25.50) compared with the optimal care group (0.08%; 95% confidence interval, 0.07-0.09; P<.001).
Conclusion:
Optimal obstetric care was more cost-effective, less costly, and clinically more effective, lowering average healthcare costs per newborn while reducing the incidence of hypoxic-ischemic encephalopathy compared with substandard care.
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