Incremental Cost of Premature Birth - a Public Health Care Payer Perspective from Hungary

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2023 Jun 23

PMID 37353814

Authors

Gabor Kovacs

Zsolt Abonyi-Toth

Petra Fadgyas-Freyler

Zoltan Kalo

Affiliations

Soon will be listed here.

Abstract

Background: Preterm birth remains a significant burden to families, health systems and societies. The aim was to quantify the incremental prematurity-related public health expenditure in Hungary and to estimate the potential impact of a decrease in the prevalence of prematurity on the public payer's spending.

Methods: Over a 6-year time horizon, public financing data of inpatient, outpatient and pharmaceutical care for children born at ≥ 25 weeks of gestation in 2009/2010 were retrieved from the Hungarian National Health Insurance Fund database. In descriptive analysis, the public payer's spending was given as cost/capita. The impact of a decrease in prematurity prevalence was specified as the total budget impact. An exchange rate of 294 Hungarian forint/Euro was applied.

Results: A total of 93,124 children (including 8.6% who were premature babies) were included in the analysis. A strong negative relationship was shown between gestational age and per capita cost. The 6-year cost of care for the cohort born at 26 weeks of gestation (28,470 Euro per capita) was 24 times higher than that for the cohort born at 40 weeks. First-year inpatient spending accounted for the largest proportion of total health care spending across all gestational ages. All investigated prematurity complications (retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular cerebral bleeding and leukomalacia) resulted in additional significant incremental spending. If 70% of pregnancies ending with preterm birth could be prolonged by 1 week, the savings would be almost 7.0 million Euros in the first 6 years of life.

Conclusion: This comprehensive analysis of prematurity-related health care spending confirmed that premature infants have much higher costs for care than those born at term in Hungary. These quantitative outcomes can provide essential inputs for the cost-effectiveness analysis of medical technologies and public health interventions that can decrease the prevalence of premature birth.

Trial Registration: Not applicable.

References

van Baaren G, Peelen M, Schuit E, van der Post J, Mol B, Kok M . Preterm birth in singleton and multiple pregnancies: evaluation of costs and perinatal outcomes. Eur J Obstet Gynecol Reprod Biol. 2015; 186:34-41. DOI: 10.1016/j.ejogrb.2014.12.024. View

Hall E, Greenberg J . Estimating community-level costs of preterm birth. Public Health. 2016; 141:222-228. DOI: 10.1016/j.puhe.2016.09.033. View

McCormick M, Litt J, Smith V, Zupancic J . Prematurity: an overview and public health implications. Annu Rev Public Health. 2011; 32:367-79. DOI: 10.1146/annurev-publhealth-090810-182459. View

Jacob J, Lehne M, Mischker A, Klinger N, Zickermann C, Walker J . Cost effects of preterm birth: a comparison of health care costs associated with early preterm, late preterm, and full-term birth in the first 3 years after birth. Eur J Health Econ. 2016; 18(8):1041-1046. DOI: 10.1007/s10198-016-0850-x. View

Cavallo M, Gugiatti A, Fattore G, Gerzeli S, Barbieri D, Zanini R . Cost of care and social consequences of very low birth weight infants without premature- related morbidities in Italy. Ital J Pediatr. 2015; 41:59. PMC: 4545779. DOI: 10.1186/s13052-015-0165-z. View

Russell R, Green N, Steiner C, Meikle S, Howse J, Poschman K . Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics. 2007; 120(1):e1-9. DOI: 10.1542/peds.2006-2386. View

Ganapathy V, Hay J, Kim J . Costs of necrotizing enterocolitis and cost-effectiveness of exclusively human milk-based products in feeding extremely premature infants. Breastfeed Med. 2011; 7(1):29-37. DOI: 10.1089/bfm.2011.0002. View

Dave H, Gordillo L, Yang Z, Zhang M, Hubbard 3rd G, Olsen T . The societal burden of blindness secondary to retinopathy of prematurity in Lima, Peru. Am J Ophthalmol. 2012; 154(4):750-5. DOI: 10.1016/j.ajo.2012.04.003. View

Lapcharoensap W, Bennett M, Xu X, Lee H, Dukhovny D . Hospitalization costs associated with bronchopulmonary dysplasia in the first year of life. J Perinatol. 2019; 40(1):130-137. PMC: 6920537. DOI: 10.1038/s41372-019-0548-x. View

10.

Fuchs F, Monet B, Ducruet T, Chaillet N, Audibert F . Effect of maternal age on the risk of preterm birth: A large cohort study. PLoS One. 2018; 13(1):e0191002. PMC: 5791955. DOI: 10.1371/journal.pone.0191002. View

11.

Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J . Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016; 388(10063):3027-3035. PMC: 5161777. DOI: 10.1016/S0140-6736(16)31593-8. View

12.

Tarricone R . Cost-of-illness analysis. What room in health economics?. Health Policy. 2005; 77(1):51-63. DOI: 10.1016/j.healthpol.2005.07.016. View

13.

Drummond M . Cost-of-illness studies: a major headache?. Pharmacoeconomics. 1992; 2(1):1-4. DOI: 10.2165/00019053-199202010-00001. View

14.

Ganapathy V, Hay J, Kim J, Lee M, Rechtman D . Long term healthcare costs of infants who survived neonatal necrotizing enterocolitis: a retrospective longitudinal study among infants enrolled in Texas Medicaid. BMC Pediatr. 2013; 13:127. PMC: 3765805. DOI: 10.1186/1471-2431-13-127. View

15.

Patel A, Johnson T, Robin B, Bigger H, Buchanan A, Christian E . Influence of own mother's milk on bronchopulmonary dysplasia and costs. Arch Dis Child Fetal Neonatal Ed. 2016; 102(3):F256-F261. PMC: 5586102. DOI: 10.1136/archdischild-2016-310898. View

16.

Marzouk A, Filipovic-Pierucci A, Baud O, Tsatsaris V, Ego A, Charles M . Prenatal and post-natal cost of small for gestational age infants: a national study. BMC Health Serv Res. 2017; 17(1):221. PMC: 5359886. DOI: 10.1186/s12913-017-2155-x. View

17.

Stephens A, Lain S, Roberts C, Bowen J, Nassar N . Survival, Hospitalization, and Acute-Care Costs of Very and Moderate Preterm Infants in the First 6 Years of Life: A Population-Based Study. J Pediatr. 2015; 169:61-8.e3. DOI: 10.1016/j.jpeds.2015.10.028. View

18.

Jacob J, Matrix Z, Skopec D, Ticho B, Arnold R . Factors associated with retinopathy of prematurity ophthalmology workload. J Perinatol. 2018; 38(11):1588-1593. PMC: 6214912. DOI: 10.1038/s41372-018-0212-x. View

19.

Thanh N, Toye J, Savu A, Kumar M, Kaul P . Health Service Use and Costs Associated with Low Birth Weight--A Population Level Analysis. J Pediatr. 2015; 167(3):551-6.e1-3. DOI: 10.1016/j.jpeds.2015.06.007. View

20.

Ionio C, Colombo C, Brazzoduro V, Mascheroni E, Confalonieri E, Castoldi F . Mothers and Fathers in NICU: The Impact of Preterm Birth on Parental Distress. Eur J Psychol. 2016; 12(4):604-621. PMC: 5114875. DOI: 10.5964/ejop.v12i4.1093. View