Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
Paediatr Perinat Epidemiol. 2022 Sep;36(5):696-705. doi: 10.1111/ppe.12906. Epub 2022 Jul 13.
Preterm birth is associated with adverse health and developmental sequelae that impose a burden on finite resources and significant challenges for individuals, families and societies.
To estimate economic outcomes at age 11 associated with extremely preterm birth using evidence from a whole population study (EPICure2 study).
The study population comprised a sample of children born at ≤26 completed weeks of gestation during 2006 in England (n = 200) and a comparison group of classmates born at term (n = 143). Societal costs were estimated using parent and teacher reports of service utilisation, and valuations of work losses and additional care costs to families. Utility scores for the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) were generated using UK and Canadian value sets. Generalised linear regression was used to estimate the impact of extremely preterm birth on societal costs and utility scores.
Unadjusted mean societal costs that excluded provision of special educational support in mainstream schools during the 11th year after birth were £6536 for the extremely preterm group and £3275 for their classmates, generating a difference of £3262 (95% confidence interval [CI] £1912, £5543). The mean adjusted cost difference was £2916 (95% CI £1609, £4224), including special educational needs provision in mainstream schools increased the adjusted cost difference to £4772 (95% CI £3166, £6378). Compared with birth at term, extremely preterm birth generated mean-adjusted utility decrements ranging from 0.13 (95% CI 0.09, 0.18) based on the UK HUI2 statistical inference tariff to 0.28 (95% CI 0.18, 0.37) based on the Canadian HUI3 tariff.
The adverse economic impact of extremely preterm birth persists into late childhood. Further longitudinal studies conducted from multiple perspectives are needed to understand the magnitude, trajectory and underpinning mechanisms of economic outcomes following extremely preterm birth.
早产与不良健康和发育后果相关，给有限的资源和个人、家庭及社会带来重大挑战。
利用全人群研究（EPICure2 研究）的证据，估算与极早产相关的 11 岁时的经济结局。
研究人群包括 2006 年在英格兰妊娠 26 周及以下出生的 200 例患儿（病例组）和同期足月出生的 143 名同学（对照组）。采用家长和教师报告的服务利用情况以及对家庭的工作损失和额外护理费用的估值来估算社会成本。使用英国和加拿大效用值集生成健康效用指数第 2 版（HUI2）和第 3 版（HUI3）的效用评分。采用广义线性回归估算极早产对社会成本和效用评分的影响。
出生后第 11 年未在主流学校提供特殊教育支持的情况下，未调整的社会总成本为极早产组 6536 英镑，对照组 3275 英镑，差异为 3262 英镑（95%置信区间[CI] 1912 英镑，5543 英镑）。调整后的平均成本差异为 2916 英镑（95%CI 1609 英镑，4224 英镑），包括在主流学校提供特殊教育需求的成本差异调整后增加至 4772 英镑（95%CI 3166 英镑，6378 英镑）。与足月出生相比，极早产导致基于英国 HUI2 统计推断关税的平均调整后效用下降 0.13（95%CI 0.09，0.18），基于加拿大 HUI3 关税的平均调整后效用下降 0.28（95%CI 0.18，0.37）。
极早产的不良经济影响持续到儿童晚期。需要从多个角度开展进一步的纵向研究，以了解极早产出生后的经济结局的大小、轨迹和潜在机制。
