Estimates of the cost and length of stay changes that can be attributed to one-week increases in gestational age for premature infants
Introduction
Medical and technological advances in the care of infants have resulted in dramatic reductions in neonatal mortality, especially for low birth weight (< 2500 g) and very low birth weight (< 1500 g) infants [1], [2]. While birth weight specific survival has improved markedly, rates of prematurity and extreme prematurity have remained relatively stable over time. While many interventions have been tried, until recently there was relatively little that could be done to prevent premature labor [3]. However, the recent report that 17 alpha-hydroxyprogesterone caproate therapy significantly increased gestation in mothers who had had a previous preterm birth gives hope that other successful therapies may be in the offing [4].
While clinical trials can demonstrate effectiveness, the very large variations in the costs of care for premature infants can result in substantial uncertainty about the cost-effectiveness of interventions [5]. Even trials with hundreds of infants will not have very many infants of any given weight or gestational age at birth. Clinical trials are further biased because they tend to occur in large academic medical centers which tend to have better outcomes than other hospitals [6]. This will affect the neonatal cost estimates because most extremely premature infants die in the first few days. Thus, having population-based estimates with large samples would provide a better basis for estimating the cost-effectiveness of any successful perinatal intervention to prevent or delay premature labor. Gilbert et al. reported neonatal costs by week of gestation for all births in California for 1996 [7]. But, they only reported the mean and median costs, with no information about the distribution of costs at each week of gestation. The purpose of this study is to provide population-based estimates of the costs of neonatal care by week of gestation and use information on the distributions of costs to provide plausible ranges on the potential shifts in costs that may arise as a result of interventions that delay premature labor. These are provided for both neonatal costs and neonatal lengths of stay.
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Methods
Following approval of this study by the Stanford University Institutional Review Board and the California Department of Health and Human Services Committee for the Protection of Human Subjects, linked data were obtained for the 1998–2000 California birth cohorts. These data link the California Office of Statewide Health Planning and Development (OSHPD) infant hospital discharge summaries to the infant vital statistics data (birth and death certificate data). Infant hospital discharge summaries
Results
There were a total of 264,870 cases in the linked data with a gestational age between 24 and 37 completed weeks. We deleted 354 cases with a birth weight < 500 g. 33,296 cases were deleted due to incomplete cost or length of stay information, or if they were identified as having a non-creditable cost estimate. A total of 38,054 cases were deleted because they failed the gestational age criteria described above. The resulting final sample was 193,167 infants.
Table 1 reports the distributions of
Discussion
This analysis provides summaries of the neonatal costs and lengths of stay by week of gestation from a large, population-based dataset. These data provide more reliable information on which to base estimates of the cost-effectiveness of interventions to prevent or delay premature labor than can be obtained from the relatively small samples of randomized controlled trials. Further, because these data were population-based, they were not subject to any bias with respect to the types of hospitals
Acknowledgment
This work was supported by the National Institutes of Health, grant HD-36914 (National Institute of Child Health and Human Development and Agency for Healthcare Research and Quality).
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