Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, M4 wing NICU, Toronto, Ontario, M4N3M5, Canada.
Surgery and Health Policy Management and Evaluation, University of Toronto, Women's College Hospital, Toronto, Ontario, Canada.
BMC Pediatr. 2021 Mar 17;21(1):134. doi: 10.1186/s12887-021-02600-8.
Regional variation in cost of neonatal intensive care for extremely preterm infant is not documented. We sought to evaluate regional variation that may lead to benchmarking and cost saving.
An analysis of a Canadian national costing data from the payor perspective. We included all liveborn 23-28-week preterm infants in 2011-2015. We calculated variation in costs between provinces using non-parametric tests and a generalized linear model to evaluate cost variation after adjustment for gestational age, survival, and length of stay.
We analysed 6932 infant records. The median total cost for all infants was $66,668 (Inter-Quartile Range (IQR): $4920-$125,551). Medians for the regions varied more than two-fold and ranged from $48,144 in Ontario to $122,526 in Saskatchewan. Median cost for infants who survived the first 3 days of life was $91,000 (IQR: $56,500-$188,757). Median daily cost for all infants was $1940 (IQR: $1518-$2619). Regional variation was significant after adjusting for survival more than 3 days, length of stay, gestational age, and year (pseudo-R = 0.9, p < 0.01). Applying the model on the second lowest-cost region to the rest of the regions resulted in a total savings of $71,768,361(95%CI: $65,527,634-$81,129,451) over the 5-year period ($14,353,672 annually), or over 11% savings for the total program cost of $643,837,303 over the study period.
Costs of neonatal intensive care are high. There is large regional variation that persists after adjustment for length of stay and survival. Our results can be used for benchmarking and as a target for focused cost optimization, savings, and investment in healthcare.
新生儿重症监护的成本在不同地区存在差异，但目前尚无相关记录。我们旨在评估这种差异，以便进行基准比较和节省成本。
这是一项从支付方角度出发的加拿大全国成本数据分析。我们纳入了 2011 年至 2015 年间所有 23-28 周早产儿的活产儿。我们使用非参数检验和广义线性模型来计算各省之间的成本差异，并在调整胎龄、存活率和住院时间后评估成本差异。
我们分析了 6932 名婴儿的记录。所有婴儿的总费用中位数为 66668 加元（四分位距 (IQR)：4920-125551 加元）。各地区的中位数差异超过两倍，范围从安大略省的 48144 加元到萨斯喀彻温省的 122526 加元。存活至生命最初 3 天的婴儿的中位费用为 91000 加元（IQR：56500-188757 加元）。所有婴儿的中位日费用为 1940 加元（IQR：1518-2619 加元）。在调整超过 3 天的存活率、住院时间、胎龄和年份后，区域差异具有统计学意义（伪 R=0.9，p<0.01）。将第二低费用地区的模型应用于其余地区，可在 5 年内节省 71768361 加元（95%CI：65527634-81129451 加元）（每年 14353672 加元），或在研究期间节省 643837303 加元的总项目成本的 11%以上。
新生儿重症监护的成本很高。在调整住院时间和存活率后，仍存在较大的地区差异。我们的结果可用于基准比较，并作为集中优化成本、节省成本和投资医疗保健的目标。
