Department of Paediatrics, Turku University Hospital, Turku, Finland.
Ann Med. 2011 Jun;43 Suppl 1:S47-53. doi: 10.3109/07853890.2011.586359.
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.
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.
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.
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.
本文总结了早产儿子研究的主要发现，该研究为 Performance, Effectiveness and Costs of Treatment episodes（PERFECT）研究的一部分。我们研究了分娩医院水平和分娩时间对极低胎龄/极低出生体重（VLGA/VLBW）婴儿死亡率和发病率的影响，以及对其治疗的成本效益。
本研究纳入了 2000-2007 年芬兰所有胎龄<32 周或出生体重<1501g 的婴儿。不同的队列取决于时间点。
如果在二级医院出生，或者在二级医院的非办公时间出生，那么活产的 VLGA/VLBW 婴儿的一年死亡率更高，如果在三级医院出生，或者在三级医院的办公时间出生，那么死亡率则更低。三分之二的 VLGA/VLBW 患者没有研究中任何一种与早产相关的疾病。到 4 岁时，每 QALY 的平均成本为 19245 欧元；有长期疾病的 VLGA/VLBW 婴儿的成本更高。
在三级医院分娩可提高 VLGA/VLBW 婴儿的生存率。结果表明，小医院夜间护理能力不足。尽管初始成本较高，但到 4 岁时，VLGA/VLBW 婴儿的治疗已具有成本效益。通过降低长期发病率，成本效益可以进一步提高。
