J Paediatr Child Health. 1997 Jun;33(3):202-8.
To determine the incremental cost of improving the outcome for extremely low birthweight (ELBW, birthweight 500-999 g) infants born in Victoria after the introduction of exogenous surfactant (the post surfactant era).
This was a geographically determined cohort study of ELBW children in Victoria, Australia of consecutive livebirths born in three distinct eras: (i) 1979-80 (n = 351); (ii) 1985-87 (n = 560); and (iii) 1991-92 (n = 429). Exogenous surfactant was first used in Victoria in March, 1991. The consumption of nursery resources per livebirth, and the survival and sensorineural disability rates at 2 years of age for each era were investigated. Utilities were assigned as follows: 0 for dead, 0.4 for severe disability, 0.6 for moderate disability, 0.8 for mild disability, and 1 for no disability. Utilities were multiplied for more than one disability. Dollar costs were assumed to be $1470 ($A 1992) per day of assisted ventilation, and one dose of exogenous surfactant was assumed to be equivalent to one third of a day of assisted ventilation. Cost-effectiveness (additional costs per additional survivor or life-year gained) and cost-utility (additional costs per additional quality-adjusted survivor or life-year gained) ratios were calculated for the pre-surfactant era (1985-87 vs 1979-80), and for the post surfactant era (1991-92 vs 1985-87).
Considering only the costs incurred during the primary hospitalization, cost-effectiveness and cost-utility ratios were lower (i.e. economically better) in the post surfactant era than in the pre-surfactant era (pre-surfactant vs post surfactant; $7040 vs $4040 per life year gained; $6700 vs $5360 per quality-adjusted life year gained). Both ratios fell with increasing birthweight. In contrast with the pre-surfactant era, cost-utility ratios were less favourable than cost-effectiveness ratios in the post surfactant era. With costs for long-term care of severely disabled children added, both cost ratios were higher in the post surfactant era.
The incremental cost during the primary hospitalization of improving the outcome for ELBW infants has fallen in the post surfactant era.
确定在引入外源性表面活性剂后（表面活性剂时代之后），改善维多利亚州出生的极低出生体重（ELBW，出生体重500 - 999克）婴儿预后的增量成本。
这是一项对澳大利亚维多利亚州ELBW儿童进行的基于地理位置的队列研究，研究对象为三个不同时期连续出生的活产婴儿：（i）1979 - 1980年（n = 351）；（ii）1985 - 1987年（n = 560）；以及（iii）1991 - 1992年（n = 429）。外源性表面活性剂于1991年3月首次在维多利亚州使用。调查了每个时期每个活产婴儿的新生儿重症监护室资源消耗情况，以及两岁时的存活率和感觉神经性残疾率。效用值分配如下：死亡为0，严重残疾为0.4，中度残疾为0.6，轻度残疾为0.8，无残疾为1。多种残疾情况的效用值相乘计算。假定辅助通气每天的美元成本为1470美元（1992年澳元），一剂外源性表面活性剂相当于三分之一天的辅助通气成本。计算了表面活性剂时代之前（1985 - 1987年与1979 - 1980年相比）以及表面活性剂时代之后（1991 - 1992年与1985 - 1987年相比）的成本效益比（每增加一名存活者或获得的生命年所增加的成本）和成本效用比（每增加一名质量调整后的存活者或获得的生命年所增加的成本）。
仅考虑初次住院期间产生的成本，表面活性剂时代之后的成本效益比和成本效用比低于表面活性剂时代之前（表面活性剂时代之前与表面活性剂时代之后相比；每获得一个生命年分别为7040美元和4040美元；每获得一个质量调整生命年分别为6700美元和5360美元）。两个比值均随出生体重增加而下降。与表面活性剂时代之前相比，表面活性剂时代之后的成本效用比不如成本效益比有利。加上重度残疾儿童的长期护理成本后，表面活性剂时代之后的两个成本比值均更高。
在表面活性剂时代之后，改善ELBW婴儿预后的初次住院期间的增量成本有所下降。
