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Dates: 2006-2007
Funding: Tommy's - the baby charity
Information: Stavros Petrou

The high rates of morbidity and mortality arising from preterm birth impose a considerable burden on finite health care resources. Preterm infants are at increased risk of a range of adverse neonatal outcomes including chronic lung disease, severe brain injury, retinopathy of prematurity, necrotizing enterocolitis and neonatal sepsis.

In later life, preterm infants are at increased risk of motor and sensory impairment, learning difficulties and behavioural problems. Although the health sequelae of preterm birth are well documented, relatively little is known about the economic consequences. The economic consequences include the costs of neonatal care as well as the costs associated with living with disabilities.

In this study a decision-analytic model was used to assess the clinical and economic consequences of preterm birth. The model used a decision tree to describe the life course of infants born at low gestational age, and to estimate changes in health status and economic outcomes resulting from specific adverse sequelae of preterm birth. The analysis was conducted from a public sector perspective with a time horizon of up to 18 years. Detailed epidemiological and economic data were required to populate the model.

There is a substantial literature on the short and (to a lesser extent) long term clinical consequences of prematurity. Therefore, a selective review was carried out to estimate the proportions of children following different paths in the model in different gestational age categories. A parallel (overlapping) review was carried out to estimate the costs associated with each pathway. Where different publications suggest different probabilities for intermediate outcomes, such as hospital readmission, all the figures were collected and applied in probabilistic sensitivity analyses. Where there are gaps in the evidence, secondary data sources were analysed. These included the Oxford Record Linkage Study, the EPICure study and NPEU trials with ongoing follow-up.

The final model estimated the costs associated with a hypothetical cohort of 669601 children and is based on live birth and preterm birth data from England and Wales in 2006. The total cost of preterm birth to the public sector was estimated to be £2.946 billion, and an inverse relationship was identified between gestational age at birth and the average public sector cost per surviving child. The incremental cost per preterm child surviving to 18 years compared with a term survivor was estimated at £22885. The corresponding estimates for a very and extremely preterm child were substantially higher at £61781 and £94740, respectively. These results were published in Pediatrics in February 2009.

Publications

Mangham, L, Petrou, S, Doyle, L, Draper, E, and Marlow, N (2009). The childhood costs of preterm birth in England and Wales: A decision-analytic Markov modelling study

Pediatrics, 123(2):e312-27.

Petrou, S (2006). Preterm birth: what are the relevant economic issues? Early Hum Dev 82(2):75-6.

Petrou, S, Henderson, J, Bracewell, M, Hockley, C, Wolke, D, and Marlow, N (2006). Pushing the boundaries of viability: the economic impact of extreme preterm birth. Early Hum Dev 82(2):77-84.