Hospital Costs and Quality of Life During 4 Years After Very Preterm Birth

Objective: To evaluate the effect of gestational age and prematurity-related morbidities on hospital costs and cost per quality-adjusted life-year (QALY) during the first 4 years of life.

Design: Population-based study using national register data and parental questionnaires.

Setting: Finland.

Participants: All 2064 very preterm children (gestational age <32 weeks or birth weight <1501 g) and all 200 609 full-term control individuals (mean [SD] gestational age, 37 [0] to 41 [6] weeks) born from January 1, 2000, through December 31, 2003.

Main Exposure: Prematurity.

Main Outcome Measures: Costs of hospital care and cost per QALY at 4 years of age according to gestational age and prematurity-related morbidities.

Results: By 4 years of age, the cost per QALY for full-term controls (in 2008 currency) was euro1181 (US$1736). In very preterm children, the average cost per QALY was euro19 245 ($28 290), ranging from euro11 824 to euro54 324 ($17 381 to $79 856) and increasing with decreasing gestational age. The cost per QALY was euro14 368 ($21 121) for those without any of the studied morbidities and euro36 110 ($53 082) for those with 2 or more morbidities. The costs of the initial hospital stay comprised 79.5% of the total 4-year hospital costs in very preterm children.

Conclusions: We conclude that the cost per QALY in this patient group is at an acceptable level by 4 years of age. Because the initial hospital care episode accounted for most of the costs, the cost per QALY will decrease with each additional follow-up year.