Review PaperEconomic analysis of the costs associated with prematurity from a literature review
Introduction
Because of their consequences in terms of mortality and morbidity, preterm births, defined as childbirths occurring at less than 37 completed weeks or 259 days of gestation, are a public health problem worldwide.1, 2 The rate of prematurity is estimated at 7.5% in developed countries, and is steadily increasing in France (from 6.8% in 1998 to 7.4% in 2010) as in other industrialized countries since the early 1980s.1, 3, 4, 5, 6 This evolution can mostly be attributed to the increased use of assisted reproduction and obstetric interventions, such as induced labour and Caesarean section.6
Prematurity is known to be associated with a higher risk of adverse consequences for health in the long-term compared with term births, and therefore requires specific health, education and social services.2, 7, 8 Children born prematurely are mostly affected in the short term by adverse neonatal outcomes, including chronic lung disease, severe brain injury, retinopathy of prematurity, necrotizing enterocolitis and neonatal sepsis. In the long term, they are at an increased risk of motor and sensory impairment, learning difficulties, behavioural problems and pulmonary dysfunction.2, 9 It has also been estimated that half of the children with severe disabilities were born prematurely.7
To be able to justify the size of resource allocations for health strategies, knowledge of the economic burden of prematurity and identification of the main costs associated with its management are of paramount importance. However, the cost of prematurity remains unknown in France. Only two French studies were published on this topic in 1984, but they cannot be extrapolated to the current French health system.10, 11 In addition, questions arise about the transferability of results from other countries to France. Several reviews in the literature analysed the economic consequences of preterm birth. All reported the inverse relationship between costs and degree of prematurity.8, 12, 13, 14, 15, 16 However, the main difference between them concerned the choice of criteria to define prematurity. GA is considered the official criterion by the World Health Organization to define prematurity.1, 12 But it was not used exclusively in all studies, and birth weight was also often reported.
Therefore, by carrying out a review of the literature, the objective of this article was to analyse the published cost-of-illness studies that assessed the cost of prematurity according to the GA at birth alone.
Section snippets
Inclusion of studies for the review of the literature
A large computer search was conducted using medical and economic databanks: Medline, ScienceDirect, The Cochrane Library, Econlit and Business Source Premier, but also the French database in Public Health (named BDSP).17 Keyword sequences related to ‘prematurity’ and ‘costs’ were used (Appendix 1).
The articles for the review of the literature were included following three consecutive steps (Fig. 1). In the first step, all of the studies identified in the databank search were imported using
General description of included studies
A total of 2760 papers were imported using Endnote® software, leading to a total of 2617 articles after eliminating duplicates. After application of all of the criteria, and the exclusion of studies that assessed childhood costs over only one year,24, 25 18 articles remained9, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 (Fig. 1). Thirteen were American studies,26, 27, 28, 29, 31, 32, 33, 35, 37, 39, 40, 41, 42 three were English,9, 36, 38 and only two were based on
Discussion
The objective of this paper was to analyse the cost of prematurity according to studies published during the two last decades. The studies were identified using a strict search of the literature. In order to compare costs more meaningfully, they were presented according to follow-up periods and GA categories, which is the main originality of this paper. The main results were the inverse relationship between the costs of prematurity and GA, whatever the follow-up period, and the huge variability
Acknowledgements
The authors would sincerely like to thank Dr. Desmedt and Dr Llorca (Centre d'Etudes Monétaires et Financières, Laboratoire d'Economie et de Gestion, FRE 3496 CNRS, Burgundy University, Dijon, France) for their advice on the use of PPP conversion.
Ethical approval
None sought.
Funding
This work was conducted as part of a study funded by a grant from Abbvie.
Competing interests
None declared.
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