The Trend in Costs of Tertiary-Level Neonatal Intensive Care for Neonates Born Preterm at 220/7-286/7 Weeks of Gestation from 2010 to 2019 in Canada

Abstract

To describe the trend in costs over 10years for tertiary-level neonatal care of infants born 220/7-286/7weeks of gestation during an ongoing Canadian national quality improvement project. Clinical characteristics, outcomes, and third-party payor costs for the tertiary neonatal care of infants born 220/7-286/7weeks of gestation between the years 2010 and 2019 were analyzed from the Canadian Neonatal Network database. Costs were estimated using resource use data from the Canadian Neonatal Network and cost inputs from hospitals, physician billing, and administrative databases in Ontario, Canada. Cost estimates were adjusted to 2017 Canadian dollars (CAD). A generalized linear mixed-effects model with gamma regression was used to estimate trends in costs. Between 2010 and 2019, the number of infants born <24weeks of gestation increased from 4.4% to 7.7%. The average length of stay increased from 68days to 75days. Unadjusted average±SD total costs per neonate were $120 717±$93 062 CAD in 2010 and $132 774±$93 161 CAD in 2019. After adjustment for year, center, and gestation, total costs and length of stay increased significantly, by $13 612 CAD (P<.01) and 8.1days (P<.01) over 10years, respectively; whereas costs accounting for LOS remained stable. The total costs and length of stay for infants 220/7-286/7weeks of gestation have increased over the past decade in Canada during an ongoing national quality improvement initiative; however, there was an increase in the number and survival of neonates at the age of periviability.