Preterm Birth and Total Health Care Use and Costs in the First 5 Years of Life: A Population-based Study

Serena Yu; Kei Lui; Denzil G Fiebig; Javeed Travadi; Caroline S E Homer; Lynn Sinclair; Vanessa Scarf; Rosalie Viney

doi:10.1016/j.jpeds.2023.01.006

Preterm Birth and Total Health Care Use and Costs in the First 5 Years of Life: A Population-based Study

J Pediatr. 2023 Jul:258:113327. doi: 10.1016/j.jpeds.2023.01.006. Epub 2023 Jan 16.

Authors

Serena Yu¹, Kei Lui², Denzil G Fiebig³, Javeed Travadi⁴, Caroline S E Homer⁵, Lynn Sinclair⁶, Vanessa Scarf⁶, Rosalie Viney⁷

Affiliations

¹ Faculty of Health, Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia. Electronic address: serena.yu@uts.edu.au.
² Faculty of Medicine and Health, School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
³ Business School, School of Economics, University of New South Wales, Sydney, Australia.
⁴ School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
⁵ Maternal, Child, and Adolescent Health, Burnet Institute, Melbourne, Australia; Faculty of Health, University of Technology Sydney, Sydney, Australia.
⁶ Faculty of Health, University of Technology Sydney, Sydney, Australia.
⁷ Faculty of Health, Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia.

PMID: 36657660
DOI: 10.1016/j.jpeds.2023.01.006

Abstract

Objectives: To investigate the relationship between preterm birth and hospital/out-of-hospital care and costs over the first 5 years of life.

Study design: Birth data from a population-based cohort of 631 532 infants born between 2007 and 2013 were linked probabilistically with data on hospitalizations, primary and secondary care, and the use of medications. We analyzed the distribution of health care use and public health care costs for infants who survived at least 5 years, comparing the outcomes of extremely preterm (<28 weeks of gestation), very preterm (28-32 weeks), moderate to late preterm (32-37 weeks), and term infants (at least 37 weeks). A linear regression model was used to investigate the effect of preterm birth on these outcomes, controlling for important confounders including pregnancy and birth complications, neonatal morbidity, survival, and maternal socioeconomic characteristics.

Results: Preterm birth has a statistically significant and economically relevant effect on health care use and costs in the first 5 years of life. Compared with a term infant, preterm infants born at 32-36 weeks, 28-32 weeks, and <28 weeks of gestation had, respectively, an average of 7.0 (SE 0.06), 41.6 (0.18), and 68.7 (0.35) more hospital days; 3.1 (0.04), 11.0 (0.13), and 13.2 (0.25) more outpatient specialist physician visits; and 1.2-fold (<0.01), 6.8-fold (0.01), and 10.9-fold (0.02) higher 5-year public health care costs. Preterm infants also had statistically significantly higher levels of general practitioner visits and use of medications.

Conclusions: Higher levels of accessible care are needed for preterm infants across health care settings and over sustained periods. As our understanding of the impact of preterm birth on long-term clinical outcomes continues to improve, clinicians and policymakers should develop an accurate recognition of these needs to enable appropriate resource allocation toward research priorities and early intervention strategies.

Keywords: administrative data; health care costs; health care utilization; preterm birth.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Female
Gestational Age
Health Care Costs
Hospitalization
Humans
Infant
Infant, Newborn
Infant, Premature
Pregnancy
Premature Birth* / epidemiology
Premature Birth* / therapy
Research