Preterm Birth Causes, Consequences, and Prevention (2007) / Chapter Skim
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12 Societal Costs of Preterm Birth
12 Societal Costs of Preterm Birth
Pages 398-429
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From page 398... ...
In terms of longer-term expenditures, early intervention services cost an estimated $611 million, whereas special education services associated with a higher prevalence of four disabling conditions among premature infants added $1.1 billion. Finally, the committee estimates that lost household and labor market productivity associated with those disabilities contributed $5.7 billion.
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From page 399... ...
, whereas special education services associated with a higher prevalence of four disabling conditions including cerebral palsy (CP) , mental retardation (MR)
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From page 400... ...
15,887 976 16,863 611 1,094 5,694 1,935 26,197 Per case 31,290 1,920 33,210 1,203 2,150 11,214 3,812 51,589 NOTE: All amounts are in 2005 dollars. 4 DD = the four developmental disabilities.
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From page 401... ...
Although extremely preterm births represent just 6 percent of all preterm births, extremely preterm infants accounted for more than one-third of the total medical costs associated with preterm birth through 7 years of age. On the other hand, because of the much higher proportion of preterm infants born at 28 to 36 weeks of gestation, very preterm infants (those born at 28 to 31 weeks of gestation)
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From page 402... ...
Caregiver costs appropriately include travel expenses for extended care of the preterm infant, in addition to the incremental value of time devoted to caring for the infant or child born preterm. Insufficient information was available to estimate reliably the national burden for all of the cost categories listed above.
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From page 403... ...
. Certain studies have provided estimates of inpatient hospitalization costs exclusively for infants born with extremely low birth weights (The Victorian Infant Collaborative Study Group, 1997)
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From page 404... ...
The detailed estimates of costs presented here were based strictly on the cohort covered under IHC Health Plans, as records of service utilization and cost were comprehensive for that cohort. The application of exclusion criteria based on clear coding errors for gestational age (less than 22 weeks or more than 43 weeks of gestation)
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From page 405... ...
remaining at 48 months by gestational age were 36 (40 percent) among those born at less than 28 weeks of gestation, 73 (42 percent)
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From page 406... ...
revealed that the rate of neonatal intensive care unit utilization, the average length of stay, and the average cost of treatment for the initial hospitalization by gestational age were not significantly different between those who were covered by IHC Health Plans and those who were covered by Medicaid or other commercial insurance in IHC facilities. With the incorporation of adjustments for mortality, in other words, the IHC Health Plan cohort yielded reliable estimates of average service utilization across plans by gestational age and BW.
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From page 407... ...
1.9b 2.6c 2.73 a NA NA 3.4 1.5 (1.7) Birth weight (g)
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From page 408... ...
The selection of infants was made on the basis of specific International Classification of Diseases (Ninth Revision) and diagnosis-related group codes and not on the basis of a reported gestational age or BW.
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From page 409... ...
Price-adjusted cost comparisons of initial and early hospital stays by BW between the IHC cohort and those reported in other analyses, however, provided additional support for the conclusion that such differences may not be consequential. An analysis of VLBW infants (birth weights of <1,500 grams)
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From page 410... ...
1,895 266 129 64 NOTE: The data are based on the 1998 to 2000 birth cohort covered under IHC Health Plans. The birth-year cost is adjusted for national rates of infant mortality by gestational age (infant deaths were assigned to the first month of life for those born at less than 28 weeks of gestation and to the end of the neonatal period for those born at 28 to 36 weeks of gestation)
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From page 411... ...
Although early inpatient costs are disproportionate relative to subsequent costs, postinfancy medical care costs associated with preterm birth are not insignificant. Incremental costs for outpatient care exceed those for inpatient care beginning in the second year of life, and incremental outpatient care costs continue for children born preterm through age 4 years, regardless of gestational age.
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From page 412... ...
The concentration of neonatal intensive care among those born at the lowest gestational ages, coupled with its very high cost, is a primary driver behind this gradient. Although the average cost reflects the generally higher cost of preterm birth with progressive decreases in gestational age, the variance of the cost is substantially higher among preterm infants than among term infants.
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From page 413... ...
TABLE 12-6 Outpatient Medical Care Cost per Case in the Upper Tail of the Cost Distribution by Gestational Age Medical Care Cost (dollars) Year 2 Years 3–7 Gestational Age (wk)
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From page 414... ...
The birth-year cost was adjusted for national rates of infant mortality by gestational age (infant deaths were assigned to the first month of life for those born at less than 28 weeks of gestation and to the end of the neonatal period for those born at 28 to 36 weeks of gestation)
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From page 415... ...
More research that formally accounts for comorbidities to explain the variance in cost associated with preterm birth is required. Finding 12-2: The variance in the costs associated with preterm birth is large, even within gestational age groups.
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From page 416... ...
(0.6–0.8) aBirth cohort of 3-year-old survivors for children with cerebral palsy, mental retardation, hearing loss, or vision impairment.
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From page 417... ...
. Excess cases of the four developmental disabilities associated with preterm birth were based on unpublished tabulations from MADDSP on the prevalence of the four developmental disabilities by gestational age for the cohort born from 1981 to 1991 surviving to age 3 years.
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From page 418... ...
. Reprinted from Using Survey Data to Study Disability: Results from the National Health Interview Survey on Disability, Honeycutt et al., Economic costs of mental retardation, cerebral palsy, hearing loss, and vision impairment, Pg.
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From page 419... ...
Prevalence by birth weight category demonstrated similarly sharp gradients (Table 12-10)
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From page 420... ...
No. of 3-year survivors: 1986–1993 birthsd 1,179 2,231 19,112 50,960 NOTE: The data represent the birth weight-specific prevalence of select developmental disabilities among 3- to 10-year-old children who were born in Atlanta, Georgia, from 1981 to 1993 and who survived to 3 years of age.
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From page 421... ...
(0.7–0.9) 189,441 29,656 292,579 aBirth cohort of 3-year-old survivors for children with cerebral palsy, mental retardation, hearing loss, or vision impairment.
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From page 422... ...
LBW is clearly a risk factor for developmental disabilities and their associated costs and one that is correlated with gestational age. The extent to which these risk factors contribute independently to these developmental disability costs is not fully understood.
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From page 423... ...
If incremental EI services were delivered in the rest of the country at the same level that they are delivered in Massachusetts, the incremental cost of such services would be an estimated $1,200 per preterm child, or a total of $611 million in 2005 dollars.2 SPECIAL EDUCATION COSTS Much of the literature on the rates of receipt of special education by newborn status has focused on LBW infants, particularly VLBW and extremely low birth weight infants, and has not been estimated from population-based samples (Pinto-Martin et al., 2004)
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From page 424... ...
In that respect, these special education cost estimates are conservative proxies of the full cost of special education services provided to those born preterm. As discussed in Chapter 11, the receipt of special education services is quite prevalent among children born preterm, beyond those with the specific disabilities.
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From page 425... ...
The effect of replacement on cost, from a societal perspective, might translate into a net reduction in indirect mortality costs associated with the preterm infant, for example, but the amount of reduction would depend on the rate and timing of the replacement as well as on the overall health status of the replacement child. Another potential complication arises with the treatment of multiple gestations associated with preterm birth and the extent to which productivity associated with the multiple gestations should be considered jointly in the analysis of the costs of preterm birth.
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From page 426... ...
On the basis of those data, with adjustments for geographic differences in cost and for inflation, the incremental delivery costs by gestational age were $11,737, $9,153, and $2,613 for infants born at less than 28, 28 to 31, and 32 to 36 weeks of gestation, respectively. These excess maternal delivery costs associated with preterm birth translated into $1.9 billion in total costs in 2005.
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From page 427... ...
ECONOMIC EVALUATION OF INTERVENTIONS TO REDUCE PRETERM BIRTH AND ITS CONSEQUENCES Economic evaluation of interventions that can be used to reduce the rates of preterm birth and its adverse consequences can aid in decision making regarding the development and integration of new technologies and programs. The techniques for such an evaluation take on several different forms.
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From page 428... ...
In a similar approach applied to LBW, another study found that even small increases in BW could generate significant savings in medical care costs in the first year of life, although such an incremental weight gain among those infants born with a birth weight below a threshold of 750 grams might generate increases in medical costs (Rogowski, 1998)
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From page 429... ...
More research on the long-term and nonmedical care costs associated with preterm birth, including maternal and caregiver costs, needs to be conducted to have a more comprehensive understanding of its societal burden. Such research should also address the distribution of cost by gestational age and across public and private payers.
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