Pushing the boundaries of viability: The economic impact of extreme preterm birth

Abstract

Background Previous assessments of the economic impact of preterm birth focussed on short term health service costs across the broad spectrum of prematurity. Objective To estimate the societal costs of extreme preterm birth during the sixth year after birth. Methods Unit costs were applied to estimates of health, social and broader resource use made by 241 children born at 20 through 25 completed weeks of gestation in the United Kingdom and Republic of Ireland and a comparison group of 160 children born at full term. Societal costs per child during the sixth year after birth were estimated and subjected to a rigorous sensitivity analysis. The effects of gestational age at birth on annual societal costs were analysed, first in a simple linear regression and then in a multiple linear regression. Results Mean societal costs over the 12 month period were £9541 (standard deviation £11,678) for the extreme preterm group and £3883 (£1098) for the term group, generating a mean cost difference of £5658 (bootstrap 95% confidence interval: £4203, £7256) that was statistically significant ( P < 0.001). After adjustment for clinical and sociodemographic covariates, sex-specific extreme preterm birth was a strong predictor of high societal costs. Conclusion The results of this study should facilitate the effective planning of services and may be used to inform the development of future economic evaluations of interventions aimed at preventing extreme preterm birth or alleviating its effects.