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Cost of neonatal abstinence syndrome: an economic analysis of English national data held in the National Neonatal Research Database
  1. Philippa Rees1,
  2. Ben Carter2,
  3. Chris Gale3,
  4. Stavros Petrou4,
  5. Beverley Botting1,
  6. Alastair G Sutcliffe1
  1. 1 Population Policy and Practice, University College London Institute of Child Health, London, UK
  2. 2 Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  3. 3 Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
  4. 4 Nuffield Department of Primary Care and Health Science, University of Oxford, Oxford, UK
  1. Correspondence to Dr Philippa Rees, Population Policy and Practice, University College London Institute of Child Health, London WC1N 1EH, UK; p.rees{at}ucl.ac.uk

Abstract

Objective To determine the incidence of neonatal abstinence syndrome (NAS) across neonatal units, explore healthcare utilisation and estimate the direct cost to the NHS.

Design Population cohort study.

Setting NHS neonatal units, using data held in the National Neonatal Research Database.

Participants Infants born between 2012 and 2017, admitted to a neonatal unit in England, receiving a diagnosis of NAS (n=6411).

Main outcome measures Incidence, direct annual cost of care (£, 2016–2017 prices), duration of neonatal unit stay (discharge HR), predicted additional cost of care, and odds of receiving pharmacotherapy.

Results Of 524 334 infants admitted during the study period, 6411 had NAS. The incidence (1.6/1000 live births) increased between 2012 and 2017 (β=0.07, 95% CI (0 to 0.14)) accounting for 12/1000 admissions and 23/1000 cot days nationally. The direct cost of care was £62 646 661 over the study period. Almost half of infants received pharmacotherapy (n=2631; 49%) and their time-to-discharge was significantly longer (median 18.2 vs 5.1 days; adjusted HR (aHR) 0.16, 95% CI (0.15 to 0.17)). Time-to-discharge was longer for formula-fed infants (aHR 0.73 (0.66 to 0.81)) and those discharged to foster care (aHR 0.77 (0.72 to 0.82)). The greatest predictor of additional care costs was receipt of pharmacotherapy (additional mean adjusted cost of £8420 per infant).

Conclusions This population study highlights the substantial cot usage and economic costs of caring for infants with NAS on neonatal units. A shift in how healthcare systems provide routine care for NAS could benefit infants and families while alleviating the burden on services.

  • neonatology
  • health services research
  • epidemiology

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Footnotes

  • Twitter @PhilippaCRees, @DrCGale

  • Contributors PR designed the study, undertook the analysis, interpreted the data, and drafted and revised the manuscript. BC was the lead statistician; he was involved in the analysis and interpretation of data, and revising the manuscript for important intellectual content. CG was involved in the concept and design of the study, interpretation of results, supervision of the study and revising the manuscript for intellectually important content. BB was involved in the concept and design of the study, interpretation of results, supervision of the study and revising the manuscript for intellectually important content. SP was the study health economist; he was involved in the concept and design of the study, interpretation of results, supervision of the study and revising the manuscript for intellectually important content. AGS was involved in the concept and design of the study, interpretation of results, supervision of the study and revising the manuscript for intellectually important content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The Isaac Schapera Trust funded data extraction from the NNRD.

  • Competing interests CG holds grants from the National Institute of Health Research, the Mason Medical Research Foundation, the Rosetrees Foundation and the Canadian Institute for Health Research. He receives personal fees from Chiesi Pharmaceuticals. Outside of the submitted work, CG is vice-chair of the NIHR Research for Patient Benefit London Regional Assessment Panel. CG is a non-remunerated member of the Neonatal Data Analysis Unit (NDAU) steering board, which oversees the National Neonatal Research Database (NNRD).

  • Patient consent for publication Not required.

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

  • Data availability statement Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as online supplemental information. All data are held in the National Neonatal Research Database. Data are available on request to the Neonatal Data Analysis Unit.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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