The cost of preterm birth throughout childhood in England and Wales

Although the clinical sequelae of preterm birth are well documented, the information about its economic consequences is quite scant. Even if several studies have estimated the costs of preterm birth during the neonatal period, few considered the economic impact over the longer term. Moreover, two systematic reviews of the long-term costs of preterm birth highlighted the variable methodological quality of the literature. These reviews also revealed that preterm birth can result in substantial costs to the health sector after the infant's initial discharge from the hospital, since it imposes a substantial burden on special education and social services, as well as on families and caregivers. In another US study, the annual economic burden associated with preterm birth in the United States was estimated to be at least $26.2 billion, or $51,600 per infant born preterm.
Marlow and colleagues conducted a pharmacoeconomics study to estimate the economic consequences of preterm birth in England and Wales throughout childhood, by using decision-analytic modeling techniques.
In particular, a decision-analytic model was constructed to estimate the costs to the public sector over the first 18 years after birth, stratified by week of gestational age at birth. The model was designed to estimate the costs associated with a hypothetical cohort of children, the size of which was set at 669,601 to reflect the number of live births in England and Wales in 2006. Costs were estimated from a public sector perspective, which encompasses health, social and educational services, expressed in UK pounds and valued at 2006 prices.
In total, preterm birth costs £2.946 billion (US $4.567 billion) to the public sector; it was observed that an inverse relationship was identified between gestational age at birth and the average public sector cost per surviving child. The incremental cost per preterm child surviving to 18 years compared with a term survivor was estimated at £22,885 (US $35,471). The corresponding estimates for a very and extremely preterm child were substantially higher at £61,781 (US $95,760) and £94,740 (US $146,847), respectively.
Preterm birth was associated with increased costs in every cost category and for every period of childhood. Of note, despite concerns about ongoing costs after discharge from perinatal services, the largest contribution to the economic implications of preterm birth are hospital inpatient costs after birth, which are responsible for 92.0% of the incremental costs per preterm survivor.
This study has important clinical and policy implications. In addition to informing the planning of services, it can provide a basis for assessing competing research strategies. The model can also be used as a basis for simulating the costs and consequences of interventions aimed at preventing preterm birth or alleviating its effects.

Top