INTRODUCTION: This article summarizes the main findings of the preterm infant sub-study of the Performance, Effectiveness and Costs of Treatment episodes (PERFECT) study. We studied effects of birth hospital level and time of birth on mortality and morbidity and cost-effectiveness of care of very low gestational age (VLGA)/very low birth weight (VLBW) infants. MATERIAL AND METHODS: The study included all infants born below 32 weeks or 1501 g in Finland in 2000-2007. Different cohorts were used depending on the time point. RESULTS: The one-year mortality of live-born VLBW/VLGA infants was higher if born in level II versus level III hospitals, or if born during out-of-office hours in level II versus office hours in level III hospitals. Two out of three VLGA/VLBW subjects did not have any of the prematurity-related morbidities studied. The average cost of quality-adjusted life years was €19,245 by four years of age; the cost was higher in VLGA/VLBW infants with long-term morbidities. DISCUSSION: Birth in a level III hospital improved survival of VLGA/VLBW infants. Results suggest inadequate overnight competence in small hospitals. Despite high initial costs, care of VLGA/VLBW infants was already cost-effective by four years of age. Cost-effectiveness can be improved by reducing long-term morbidities.
INTRODUCTION: This article summarizes the main findings of the preterm infant sub-study of the Performance, Effectiveness and Costs of Treatment episodes (PERFECT) study. We studied effects of birth hospital level and time of birth on mortality and morbidity and cost-effectiveness of care of very low gestational age (VLGA)/very low birth weight (VLBW) infants. MATERIAL AND METHODS: The study included all infants born below 32 weeks or 1501 g in Finland in 2000-2007. Different cohorts were used depending on the time point. RESULTS: The one-year mortality of live-born VLBW/VLGA infants was higher if born in level II versus level III hospitals, or if born during out-of-office hours in level II versus office hours in level III hospitals. Two out of three VLGA/VLBW subjects did not have any of the prematurity-related morbidities studied. The average cost of quality-adjusted life years was €19,245 by four years of age; the cost was higher in VLGA/VLBW infants with long-term morbidities. DISCUSSION: Birth in a level III hospital improved survival of VLGA/VLBW infants. Results suggest inadequate overnight competence in small hospitals. Despite high initial costs, care of VLGA/VLBW infants was already cost-effective by four years of age. Cost-effectiveness can be improved by reducing long-term morbidities.
Authors: Dino Numerato; Giovanni Fattore; Fabrizio Tediosi; Rinaldo Zanini; Mikko Peltola; Helen Banks; Péter Mihalicza; Liisa Lehtonen; Sofia Sveréus; Richard Heijink; Søren Toksvig Klitkou; Eilidh Fletcher; Amber van der Heijden; Fredrik Lundberg; Eelco Over; Unto Häkkinen; Timo T Seppälä Journal: PLoS One Date: 2015-06-29 Impact factor: 3.240
Authors: Jan Bauer; David A Groneberg; Werner Maier; Roxanne Manek; Frank Louwen; Dörthe Brüggmann Journal: Int J Health Geogr Date: 2017-12-01 Impact factor: 3.918