Abstract

Background: Prematurity and extremely low birth-weight (ELBW) is a well recognised financial burden on health care in the developed world. Cost of treatment increases with decreasing gestation. While cost-benefit and cost-effectiveness analyses have been calculated and extrapolated (Gilbert et al, 2003, Payne et al, 2004), it is frequently the average and the median that is sought. An extremely high cost however is always possible at the beginning of each case, and in some, the eventuality. This study examines one such case of an infant conceived by in-vitro fertilisation (IVF), and attempts to determine the total cost from conception to discharge from the special care baby unit.

Aims:

1. To determine the precise total health care expenditure through capital and recurrent expenditure on an infant born at the margins of viability from birth to discharge from acute hospital care.

2. To accurately calculate the unit cost of care following birth at the margins of viability and subsequently the cost of care per week of a 24/40 gestation neonate.

3. To use the total and marginal cost calculated to create a pilot model for cost following the local delivery of a 24/40-week gestation infant.

Methods: We compiled a file of tests, treatments and interventions carried out on an ELBW infant. Unit costs were assigned. Appropriate values for professional input and in-patient non-medical consumables were calculated in per-unit per-day values and incorporated. Further direct costs incurred by the family were also included as well as proportional infrastructure, equipment, and refurbishment expenditures. Marginal Cost (MC) of daily treatment was measured as change in Total Cost (TC) per extra day of life. We determine total costs of treatment per extra week of life by linear regression (R2 = 0.71, p-value < 0.05). The evolution of costs was then demonstrated in terms of cumulative percentage of weekly costs over time.

Results: The total cost was found to be €665,219.88. Our analysis shows that by increasing gestation cost could be decreased by €5,167.50 per week of increased gestation, with a fixed cost of €26,608.00. Total cost and marginal costs were found to be substantially larger from published observations in other countries, including the UK and USA (Payne et al, 2004, Phibbs et al, 2006, Petru et al, 2006). This is possibly due to the detailed nature of the data set.

Conclusion & Further Work: With the total and unit cost of our index case determined, a model of health care expenditure of an infant born locally is known. In further work we apply this model as a benchmark to a large dataset of infants born in the mid-western region of Ireland.

Paper presented at the Irish Paediatric Association Annual conference, October 2006, Kemmy Business School Research Conference, Wednesday, 16th May 2007.

Irish Journal of Medical Science, 2006;175(4), October/November/December issue. pgs. 63--69

Kinsella_KBS_Margins_Submission[1].doc.1106073.pdf

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(To be presented at the 12th Association of Italian Health Economists, October 18/19, 2007)

GWdata2_feb13_2007%281%29(1).xls

[Download the data set (.xls, 1.7mb)]