Economic analysis of the costs associated with prematurity from a literature review

doi:10.1016/j.puhe.2013.09.014

Public Health

Volume 128, Issue 1, January 2014, Pages 43-62

https://doi.org/10.1016/j.puhe.2013.09.014 Get rights and content

Abstract

Objectives

To analyse published cost-of-illness studies that had assessed the cost of prematurity according to gestational age at birth.

Methods

A review of the literature was carried out in March 2011 using the following databases: Medline, ScienceDirect, The Cochrane Library, Econlit and Business Source Premier, and a French Public-Health database. Key-word sequences related to ‘prematurity’ and ‘costs’ were considered. Studies that assessed costs according to the gestational age (GA) at the premature birth (<37 weeks of gestation) in industrialized countries and during the last two decades were included. Variations in the reported costs were analysed using a check-list, which allowed the studies to be described according to several methodological and contextual criteria.

Results

A total of 18 studies published since 1990 were included. According to these studies, costs were assessed for different follow-up periods (short, medium or long-term), and for different degrees of prematurity (extreme, early, moderate and late). Results showed that whatever the follow-up period, costs correlated inversely with GA. They also showed considerable variability in costs within the same GA group. Differences between studies could be explained by the choices made, concerning i/the study populations, ii/contextual information, iii/and various economic criteria. Despite these variations, a global trend of costs was estimated in the short-term period using mean costs from four American studies that presented similar methodologies. Costs stand at over US$ 100,000 for extreme prematurity, between US$ 40,000 and US$ 100,000 for early prematurity, between US$ 10,000 and US$ 30,000 for moderate prematurity and below US$ 4500 for late prematurity.

Conclusion

This review underlined not only the clear inverse relationship between costs and GA at birth, but also the difficulty to transfer the results to the French context. It suggests that studies specific to the French health system need to be carried out.

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.

References (50)

S.W. Wen et al.
Epidemiology of preterm birth and neonatal outcome
Semin Fetal Neonatal Med
(2004)
B. Blondel et al.
La santé périnatale en France métropolitaine de 1995 à 2003: Résultats des enquêtes nationales périnatales
J Gynecol Obstet Biol Reprod
(2006)
R.L. Goldenberg
The management of preterm labor
Obstet Gynecol
(2002)
S. Petrou
Economic consequences of preterm birth and low birthweight
BJOG
(2003)
J.A. Zupancic et al.
Economics of prematurity in the era of managed care
Clin Perinatol
(2000)
S. Petrou et al.
Costs and health utilities associated with extremely preterm birth: evidence from the EPICure study
Value Health
(2009 Nov–Dec)
S. Petrou et al.
Pushing the boundaries of viability: the economic impact of extreme preterm birth
Early Hum Dev
(2006 Feb)
W.M. Gilbert et al.
The cost of prematurity: quantification by gestational age and birth weight
Obstet Gynecol
(2003)
S.J. Kilpatrick et al.
Outcome of infants born at 24–26 weeks gestation. 1: survival and cost
Obstet Gynecol
(1997)
C.S. Phibbs et al.
Estimates of the cost and length of stay changes that can be attributed to one-week increases in gestational age for premature infants
Early Hum Dev
(2006 Feb)

E.B. St John et al.

Cost of neonatal care according to gestational age at birth and survival status

Am J Obstet Gynecol

(2000 jan)

H.-M. Späth et al.

Analysis of the eligibility of published economic evaluations for transfer to a given health care system

Health Policy

(1999)

C.-D. Mullins et al.

Emerging standardization in pharmacoeconomics

Clin Ther

(1998)

D. Lapeyre et al.

Very preterm infant (<32 weeks) vs very low birth weight newborns (1500 g): comparison of two cohorts

Arch Pédiatr

(2004)

S. Beck et al.

The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity

Bull World Health Organ

(2010 Jan)

B. Blondel et al.

Enquête nationale périnatale 2010. Les naissances en 2010 et leur évolution depuis 2003

(Mai 2011)

J. Tucker et al.

Epidemiology of preterm birth

BMJ

(2004)

Expertise collective

Déficiences ou handicaps d'origine périnatale. Dépistage et prise en charge

(Juin 2004)

S. Petrou et al.

The long-term costs of preterm birth and low birth weight: results of a systematic review

Child Care Health Dev

(2001)

S. Petrou

The economic consequences of preterm birth during the first 10 years of life

BJOG

(2005)

V. Mizrahi-Tchernonog et al.

Application à l'hôpital du concept de productivité marginale. Tome 2: Analyse économique des innovations

(1984)

M. Monset-Couchard et al.

Cost of the initial care of children with birth weight less than or equal to 1500 g in 1981

Arch Fr Pediatr

(1984 Oct)

Societal costs of preterm birth

S. Petrou et al.

A structured review of the recent literature on the economic consequences of preterm birth

Arch Dis Child Fetal Neonatal

(2011)

J.F.A. Zupancic

A systematic review of costs associated with preterm birth

Cited by (48)

Small vulnerable newborns—big potential for impact
2023, The Lancet
Despite major achievements in child survival, the burden of neonatal mortality has remained high and even increased in some countries since 1990. Currently, most neonatal deaths are attributable to being born preterm, small for gestational age (SGA), or with low birthweight (LBW). Besides neonatal mortality, these conditions are associated with stillbirth and multiple morbidities, with short-term and long-term adverse consequences for the newborn, their families, and society, resulting in a major loss of human capital. Prevention of preterm birth, SGA, and LBW is thus critical for global child health and broader societal development. Progress has, however, been slow, largely because of the global community's failure to agree on the definition and magnitude of newborn vulnerability and best ways to address it, to frame the problem attractively, and to build a broad coalition of actors and a suitable governance structure to implement a change. We propose a new definition and a conceptual framework, bringing preterm birth, SGA, and LBW together under a broader umbrella term of the small vulnerable newborn (SVN). Adoption of the framework and the unified definition can facilitate improved problem definition and improved programming for SVN prevention. Interventions aiming at SVN prevention would result in a healthier start for live-born infants, while also reducing the number of stillbirths, improving maternal health, and contributing to a positive economic and social development in the society.
A cybernetic framework for predicting preterm and enhancing care strategies: A review
2021, Biomedical Engineering Advances
Preterm is viewed as the birth of a human foetus prior to 37 complete weeks of gestation. It has effects on the health of both the foetus and the mother, has financial consequences to the clinic and society as a whole, and due to its widespread occurrence is viewed as a global pandemic. Preterm can be viewed as a heterogeneous condition which is influenced by a variety of factors, the majority of which have been discussed separately in the medical literature, thus making it challenging for a comprehensive view and understanding to be formed of the topic. Using a semisystematic review methodology, this paper is structured in two parts where the first part gives a comprehensive review to what preterm is alongside a review of the topic under a number of pivotal discussion headings. Following this, in the second part of the paper, a review is conducted on the need and relevance of Artificial Intelligence (AI) models in clinical medicine, after which a cybernetic framework is proposed which utilises a combination of AI and a clinical expert within the loop (human intelligence) to yield a ‘superintelligence’ platform aimed at producing a more reliable means of preterm prediction, and also allowing for enhanced and optimised care strategies to be delivered to the pregnant patient. The paper concludes with a number of key future areas that need to be addressed in order for the overall enhancement of the proposed cybernetic framework, which includes the need for ethical sharing of patient physiological data, the further consideration of ethnicity in preterm prediction due to disparity in gestational length amongst various ethnic groups, and also the prospect of mobile pregnancy monitoring using wearables and telemedicine.
Indicated and non-indicated antibiotic administration during pregnancy and its effect on pregnancy outcomes: Role of inflammation
2020, International Immunopharmacology
Citation Excerpt :
Despite the individual health related issues, a great deal of cost is imposed on the healthcare system through caring for preterm newborns in neonatal intensive care unit [2,10]. The cost of caring for an infant with a birth weight of 500–700 gr in the United States has been estimated $225,000 and by preventing this issue, a notable amount of resources would be saved [11,12]. Not a long time ago, a retrospective study has indicated that antibiotic administration in microbe-negative pregnant women was associated with poorer pregnancy outcomes compared to microbe-positive pregnant women including preterm labor.
The objective of this study was to compare the release of endotoxin and pro-inflammatory cytokines as well as pregnancy outcomes after antibiotic exposure in healthy and bacterial infected pregnant rats. Thirty female Wistar pregnant rats were divided into five groups. Group A considered as control and received intraperitoneal saline 0.9% on 17th day of gestation or DG) and groups B and C treated with 20 mg/kg/day intravenous ceftriaxone and ceftazidime, respectively (DG: 18–20). Groups D and E received intraperitoneal E. coli and LPS on 17th DG respectively. Also, groups F and G received the same treatment as group D but they treated with the exact antibiotics mentioned for groups B and C (same dose and duration). Pregnancy outcomes as well as maternal sera levels of endotoxin, tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6 were assessed using enzyme-linked immunosorbent assay. It was shown that group B had a higher IL-1β (P = 0.003) and TNF-α (P = 0.003) levels compared to the controls (CTC). Group C expressed a lower gestational duration (P = 0.007) as well as higher IL-6 (P = 0.025) and TNF-α (P < 0.001) levels CTC. Interestingly, both group B (P = 0.021) and C (P < 0.001) had a higher rate of endotoxin release CTC. Moreover, in group C, IL-6 (P < 0.0001 and r = −0.941) had a significant correlation with gestational duration. As the results showed, antibiotic administration in non-indication condition seems to be associated with significantly higher production of endotoxin and inflammatory cytokines which increase the risk of poor pregnancy outcomes.
Towards a fuller assessment of the economic benefits of reducing air pollution from fossil fuel combustion: Per-case monetary estimates for children's health outcomes
2020, Environmental Research
Citation Excerpt :
We completed a systematic literature review to support our per-case monetary estimates. We executed our literature search in PubMed (National Library of Medicine, Bethesda, MD, USA) using a search strategy similar to that of Soilly et al., that linked economic assessment keywords to the relevant health outcomes by Boolean connectors (Soilly et al., 2014). Below we provide an example query for preterm birth (PTB).
Impacts on children's health are under-represented in benefits assessments of policies related to ambient air quality and climate change. To complement our previous compilation of concentration-response (C-R) functions for a number of children's health outcomes associated with air pollution, we provide per-case monetary estimates of the same health outcomes.
Our goal was to establish per-case monetary estimates for a suite of prevalent children's health outcomes (preterm birth, low birth weight, asthma, autism spectrum disorder, attention-deficit/hyperactivity disorder, and IQ reduction) that can be incorporated into benefits assessments of air pollution regulations and climate change mitigation policies.
We conducted a systematic review of the literature published between January 1, 2000 and June 30, 2018 to identify relevant economic costs for these six adverse health outcomes in children. We restricted our literature search to studies published in the U.S., with a supplemental consideration of studies from the U.K. and prioritized literature reviews with summary cost estimates and papers that provided lifetime cost of illness estimates.
Our literature search and evaluation process reviewed 1065 papers and identified 12 most relevant papers on per-case monetary estimates for preterm birth, low birth weight, asthma, autism spectrum disorder, and attention-deficit/hyperactivity disorder. Details are presented in full. We separately identified estimates of the lost lifetime earnings associated with the loss of a single IQ point. The final per-case cost estimates for each outcome were selected based on the most robust evidence. These estimates range from $23,573 for childhood asthma not persisting into adulthood to $3,109,096 for a case of autism with a concurrent intellectual disability.
To our knowledge, this is the first time that the child-specific health outcomes of preterm birth, low birth weight, asthma, autism spectrum disorder, attention-deficit/hyperactivity disorder, and IQ reduction have been systematically valued and presented in one place. This is an important addition to the body of health-related valuation literature as these outcomes have substantial economic costs that are not considered in most assessments of the benefits of air pollution and climate mitigation policies. In general, however, the available per-case estimates presented here did not incorporate the broad societal and long-term costs and are likely underestimates. Although our context has been air pollution and climate policies, the per-case monetary estimates presented here can be applied to other environmental exposures. Fuller assessments of health benefits to children and their corresponding economic gains will improve decision-making on environmental policy.
The cost of necrotizing enterocolitis in premature infants
2018, Seminars in Fetal and Neonatal Medicine
Citation Excerpt :
Although premature infants account for only a small percentage of newborn admissions, they account for a disproportionately large percentage of costs, with a reported $5.8 billion spent on hospital care of preterm infants in the USA in 2001 [5], with even higher estimates of $26.2 billion from the societal perspective [6]. Furthermore, many studies suggest a negative correlation between costs and gestational age as well as a positive correlation with common morbidities [7]. Russell et al. reported that mean hospital costs for preterm infants with common morbidities of prematurity are four to seven times higher than their gestational age equivalent healthy controls [5].
Necrotizing enterocolitis (NEC), a common morbidity of prematurity, affects 5–10% of premature infants with a birthweight <1500 g. The added cost remains unclear. Multiple studies report the cost of care for an infant with NEC as higher than that of well premature infants, but these studies are fraught with limitations. Surgical intervention and type of surgery appear to impact overall costs. Health care resource utilization extends beyond the birth hospitalization, particularly in those infants requiring surgery, and persists to at least three years of age. This narrative review of the literature reveals a paucity of studies and significant methodological deficiencies in most included studies. Further studies of the cost of NEC need to address the issues of significant confounding in this complex population.
Implications of Prenatal Exposure to the Spring 2011 Alabama and Missouri Tornadoes on Birth Outcomes
2019, Disaster Medicine and Public Health Preparedness

View all citing articles on Scopus

View full text

Review PaperEconomic analysis of the costs associated with prematurity from a literature review

Abstract

Objectives

Methods

Results

Conclusion

Introduction

Section snippets

Inclusion of studies for the review of the literature

General description of included studies

Discussion

Acknowledgements

Ethical approval

Funding

Competing interests

Semin Fetal Neonatal Med

J Gynecol Obstet Biol Reprod

Obstet Gynecol

BJOG

Clin Perinatol

Value Health

Early Hum Dev

Obstet Gynecol

Obstet Gynecol

Early Hum Dev

Am J Obstet Gynecol

Health Policy

Clin Ther

Arch Pédiatr

The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity

Bull World Health Organ

Enquête nationale périnatale 2010. Les naissances en 2010 et leur évolution depuis 2003

Epidemiology of preterm birth

BMJ

Déficiences ou handicaps d'origine périnatale. Dépistage et prise en charge

The long-term costs of preterm birth and low birth weight: results of a systematic review

Child Care Health Dev

The economic consequences of preterm birth during the first 10 years of life

BJOG

Application à l'hôpital du concept de productivité marginale. Tome 2: Analyse économique des innovations

Cost of the initial care of children with birth weight less than or equal to 1500 g in 1981

Arch Fr Pediatr

Societal costs of preterm birth

A structured review of the recent literature on the economic consequences of preterm birth

Arch Dis Child Fetal Neonatal

A systematic review of costs associated with preterm birth

Review Paper
Economic analysis of the costs associated with prematurity from a literature review