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Original article
Hypothermia for perinatal asphyxia: trial-based resource use and costs at 6–7 years
  1. Oliver Rivero-Arias1,
  2. Oya Eddama1,
  3. Denis Azzopardi2,3,
  4. A David Edwards2,
  5. Brenda Strohm1,
  6. Helen Campbell1
  1. 1 Nuffield Department of Population Health, National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
  2. 2 Centre for the Developing Brain, King’s College London, London, UK
  3. 3 Institute of Clinical Sciences, Imperial College, London, UK
  1. Correspondence to Dr Helen Campbell, National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK; helen.campbell{at}npeu.ox.ac.uk

Abstract

Objective To assess the impact of hypothermic neural rescue for perinatal asphyxia at birth on healthcare costs of survivors aged 6–7 years, and to quantify the relationship between costs and overall disability levels.

Design 6–7 years follow-up of surviving children from the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) trial.

Setting Community study including a single parental questionnaire to collect information on children’s healthcare resource use.

Patients 130 UK children (63 in the control group, 67 in the hypothermia group) whose parents consented and returned the questionnaire.

Interventions Intensive care with cooling of the body to 33.5°C for 72 hours or intensive care alone.

Main outcome measures Healthcare resource usage and costs over the preceding 6 months.

Results At 6–7 years, mean (SE) healthcare costs per child were £1543 (£361) in the hypothermia group and £2549 (£812) in the control group, giving a saving of −£1005 (95% CI −£2734 to £724). Greater levels of overall disability were associated with progressively higher costs, and more parents in the hypothermia group were employed (64% vs 47%). Results were sensitive to outlying observations.

Conclusions Cost results although not significant favoured moderate hypothermia and so complement the clinical results of the TOBY Children study. Estimates were however sensitive to the care requirements of two seriously ill children in the control group. A quantification of the relationship between costs and levels of disability experienced will be useful to healthcare professionals, policy makers and health economists contemplating the long-term economic consequences of perinatal asphyxia and hypothermic neural rescue.

Trial registration number This study reports on the follow-up of the TOBY clinical trial: ClinicalTrials. gov number NCT01092637.

  • perinatal asphyxial encephalopathy
  • moderate hypothermia
  • cost
  • long-term
  • disability

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/archdischild-2017-314685

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    Footnotes

    • OR-A and HC contributed equally.

    • Contributors HC helped collect the unit cost data, conducted aspects of the statistical and sensitivity analyses, wrote the manuscript with OR-A, and revised and approved the final version for submission. OE helped collect the unit cost data, conducted aspects of the statistical analysis and revised and approved the final manuscript for submission. DA was the Chief Investigator of the TOBY Children Study, secured funding for the study, contributed to the design of the statistical analysis plan and revised and approved the final manuscript for submission. ADE was a Principal Investigator of the TOBY Children Study, secured funding for the study, contributed to the design of the statistical analysis plan and revised and approved the final manuscript for submission. BS was the study coordinator of the TOBY Children Study, monitored and supervised the data collection, clarified data-related issues and revised and approved the final manuscript for submission. OR-A designed the statistical analysis plan of the study, supervised the statistical analysis, conducted the multiple imputation method for the missing data, wrote the manuscript jointly with HC and revised and approved the final version for submission.

    • Funding This study was supported by the United Kingdom Medical Research Council and the National Institute for Health Research Biomedical Research Centres at Imperial College London, the University of Oxford and King’s College London.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The National Research Ethics Service in the UK and the relevant ethics review board at each of the institutions outside the UK approved the TOBY protocol.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional unpublished data from this study.