Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
School of Health and Related Research, The University of Sheffield, Sheffield, UK.
Arch Dis Child. 2019 May;104(5):456-465. doi: 10.1136/archdischild-2018-315778. Epub 2018 Nov 9.
Despite extensive knowledge on the functional, neurodevelopmental, behavioural and educational sequelae of preterm birth, relatively little is known about its economic consequences.
To systematically review evidence around the economic consequences of preterm birth for the health services, for other sectors of the economy, for families and carers, and more broadly for society.
Updating previous reviews, systematic searches of Medline, EconLit, Web of Science, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase and Scopus were performed using broad search terms, covering the literature from 1 January 2009 to 28 June 2017. Studies reporting economic consequences, published in the English language and conducted in a developed country were included. Economic consequences are presented in a descriptive manner according to study time horizon, cost category and differential denominators (live births or survivors).
Of 4384 unique articles retrieved, 43 articles met the inclusion criteria. Of these, 27 reported resource use or cost estimates associated with the initial period of hospitalisation, while 26 reported resource use or costs incurred following the initial hospital discharge, 10 of which also reported resource use or costs associated with the initial period of hospitalisation. Only two studies reported resource use or costs incurred throughout the childhood years. Initial hospitalisation costs varied between $576 972 (range $111 152-$576 972) per infant born at 24 weeks' gestation and $930 (range $930-$7114) per infant born at term (US$, 2015 prices). The review also revealed a consistent inverse association between gestational age at birth and economic costs regardless of date of publication, country of publication, underpinning study design, follow-up period, age of assessment or costing approach, and a paucity of evidence on non-healthcare costs. Several categories of economic costs, such as additional costs borne by families as a result of modifications to their everyday activities, are largely overlooked by this body of literature. Moreover, the number and coverage of economic assessments have not increased in comparison with previous review periods.
Evidence identified by this review can be used to inform clinical and budgetary service planning and act as data inputs into future economic evaluations of preventive or treatment interventions. Future research should focus particularly on valuing the economic consequences of preterm birth in adulthood.
尽管人们对早产儿的功能、神经发育、行为和教育后遗症有了广泛的了解，但对其经济后果却知之甚少。
系统回顾早产儿对卫生服务、经济其他部门、家庭和照顾者以及更广泛的社会的经济后果的证据。
更新以前的综述，使用广泛的搜索词，对 Medline、EconLit、Web of Science、Cochrane 图书馆、护理学和相关健康文献累积索引、Embase 和 Scopus 进行系统搜索，涵盖了 2009 年 1 月 1 日至 2017 年 6 月 28 日的文献。纳入了以英语发表并在发达国家进行的报告经济后果的研究。根据研究时间范围、成本类别和差异分母（活产或幸存者），以描述性方式呈现经济后果。
从 4384 篇独特的文章中，有 43 篇符合纳入标准。其中，27 篇报告了与住院初始阶段相关的资源使用或成本估计，而 26 篇报告了出院后发生的资源使用或成本，其中 10 篇还报告了与住院初始阶段相关的资源使用或成本。只有两项研究报告了整个儿童时期发生的资源使用或成本。24 周龄出生婴儿的初始住院费用为 576972 美元（范围为 111152-576972 美元），而足月出生婴儿的初始住院费用为 930 美元（范围为 930-7114 美元）（以 2015 年美元计价）。该综述还揭示了出生时胎龄与经济成本之间的一致负相关关系，无论出版日期、出版国家、基础研究设计、随访期、评估或成本核算方法如何，以及对非医疗保健成本的证据很少。家庭因日常生活活动改变而承担的额外成本等几类经济成本在这一文献中基本被忽视。此外，与以前的综述期相比，经济评估的数量和覆盖范围并没有增加。
本综述确定的证据可用于为临床和预算服务规划提供信息，并作为未来预防或治疗干预措施经济评估的数据输入。未来的研究应特别侧重于评估早产儿成年后的经济后果。
