Phibbs Ciaran S, Schmitt Susan K
Health Economics Resource Center, Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94025, USA.
Early Hum Dev. 2006 Feb;82(2):85-95. doi: 10.1016/j.earlhumdev.2006.01.001. Epub 2006 Feb 3.
To estimate the potential savings, both in terms of costs and lengths of stay, of one-week increases in gestational age for premature infants. The purpose is to provide population-based data that can be used to assess the potential savings of interventions that delay premature delivery.
Cohort data for all births in California in 1998-2000 that linked vital records data with those from hospital discharge abstracts, including those of neonatal transport. All infants with a gestational age between 24 and 37 weeks were included. There were 193,167 infants in the sample after deleting cases with incomplete data or gestational age that was inconsistent with birth weight.
Hospital costs were estimated by adjusting charges by hospital-specific costs-to-charges ratios. Data were aggregated across transport into episodes of care. Mean and median potential savings were calculated for increasing gestational age, in one-week intervals. The 25th and 75th percentiles were used to estimate ranges.
The results are presented in matrix format, for starting gestational ages of 24-34 weeks, with ending gestational ages of 25 to 37 weeks. Costs and lengths of stay decreased with gestational age from a median of $216,814 (92 days) at 24 weeks to $591 (2 days) at 37 weeks. The potential savings from delaying premature labor are quite large; the median savings for a 2 week increase in gestational age were between $28,870 and $64,021 for gestational ages below 33 weeks, with larger savings for longer delays in delivery. Delaying deliveries <29 weeks to term (37 weeks) resulted in savings of over $122,000 per case, with the savings being over $206,000 for deliveries <26 weeks.
These results provide population-based data that can be applied to clinical trials data to assess the impacts on costs and lengths of stay of interventions that delay premature labor. They show that the potential savings of delaying premature labor are quite large, especially for extremely premature deliveries.
评估早产婴儿孕周每增加一周在成本和住院时长方面可能节省的费用。目的是提供基于人群的数据，可用于评估延迟早产干预措施的潜在节省费用情况。
1998 - 2000年加利福尼亚州所有出生婴儿的队列数据，将生命记录数据与医院出院摘要数据相链接，包括新生儿转运数据。纳入所有孕周在24至37周之间的婴儿。在删除数据不完整或孕周与出生体重不一致的病例后，样本中有193,167名婴儿。
通过根据医院特定的成本与收费比率调整收费来估算医院成本。数据按转运情况汇总为护理事件。以一周为间隔计算孕周增加时的平均和中位数潜在节省费用。使用第25百分位数和第75百分位数来估计范围。
结果以矩阵形式呈现，起始孕周为24 - 34周，结束孕周为25至37周。成本和住院时长随孕周增加而降低，从24周时的中位数216,814美元（92天）降至37周时的591美元（2天）。延迟早产的潜在节省费用相当大；孕周低于33周时，孕周增加2周的中位数节省费用在28,870美元至64,021美元之间，分娩延迟时间越长节省费用越大。将孕周小于29周的分娩延迟至足月（37周），每例可节省超过122,000美元，孕周小于26周的分娩节省费用超过206,000美元。
这些结果提供了基于人群的数据，可应用于临床试验数据，以评估延迟早产干预措施对成本和住院时长的影响。结果表明，延迟早产的潜在节省费用相当大，尤其是对于极早产分娩。
