Costs of hospitalization in preterm infants: impact of antenatal steroid therapy

Ogata, Joice Fabiola Meneguel; Fonseca, Marcelo Cunio Machado; Miyoshi, Milton Harumi; Almeida, Maria Fernanda Branco de; Guinsburg, Ruth

doi:10.1016/j.jped.2015.03.004

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ORIGINAL ARTICLES • J. Pediatr. (Rio J.) 92 (1) • Jan-Feb 2016 • https://doi.org/10.1016/j.jped.2015.03.004 linkcopy

Costs of hospitalization in preterm infants: impact of antenatal steroid therapy^☆ ^{^☆☆}

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE: To estimate the costs of hospitalization in premature infants exposed or not to antenatal corticosteroids (ACS).

METHOD: Retrospective cohort analysis of premature infants with gestational age of 26-32 weeks without congenital malformations, born between January of 2006 and December of 2009 in a tertiary, public university hospital. Maternal and neonatal demographic data, neonatal morbidities, and hospital inpatient services during the hospitalization were collected. The costs were analyzed using the microcosting technique.

RESULTS: Of 220 patients that met the inclusion criteria, 211 (96%) charts were reviewed: 170 newborns received at least one dose of antenatal corticosteroid and 41 did not receive the antenatal medication. There was a 14-37% reduction of the different cost components in infants exposed to ACS when the entire population was analyzed, without statistical significance. Regarding premature infants who were discharged alive, there was a 24-47% reduction of the components of the hospital services costs for the ACS group, with a significant decrease in the length of stay in the neonatal intensive care unit (NICU). In very-low birth weight infants, considering only the survivors, ACS promoted a 30-50% reduction of all elements of the costs, with a 36% decrease in the total cost (p = 0.008). The survivors with gestational age <30 weeks showed a decrease in the total cost of 38% (p = 0.008) and a 49% reduction of NICU length of stay (p = 0.011).

CONCLUSION: ACS reduces the costs of hospitalization of premature infants who are discharged alive, especially those with very low birth weight and <30 weeks of gestational age.

Keywords:
Preterm infant; Costs and cost analysis; Hospitalization; Glucocorticoids

	With ACS n = 170	Without ACS n = 41	p
Maternal age in years	29 ± 6	29 ± 8	0.870
N. of prenatal consultations	6 ± 3	5 ± 2	0.019
C-section birth	138 (81%)	20 (48%)	<0.001
Caucasian ethnicity	104 (61%)	19 (46%)	0.084
Primigravida	64 (37%)	12 (29%)	0.315
Hypertensive syndromes	50 (29%)	11 (26%)	0.743
Male gender	83 (48%)	20 (48%)	0.996
Weight (grams)	1302 ± 360	1278 ± 473	0.766
Gestational age (weeks)	30 ± 2	29 ± 2	0.231
SGA	36 (21%)	9 (22%)	0.916

	With ACS n = 170	Without ACS n = 41	Relative risk (95% CI)	p
Advanced resuscitation^a	27 (16%)	14 (34%)	0.46 (0.26–0.80)	0.007
SNAPPE II > 40	14 (8%)	8 (19%)	0.42 (0.18–0.93)	0.033
RDS	90 (53%)	27 (66%)	0.80 (0.61–1.04)	0.135
Surfactant use	72 (42%)	24 (58%)	0.72 (0.52–0.98)	0.062
Mechanical ventilation	90 (53%)	29 (70%)	0.74 (0.58–0.95)	0.039
Apnea	60 (35%)	16 (39%)	0.40 (0.58–1.39)	0.655
O₂ at 36 weeks	24 (14%)	9(22%)	0.64 (0.32–1.27)	0.215
PDA	48 (28%)	13 (32%)	0.89 (0.52–1.48)	0.660
Surgical PDA	13 (8%)	4 (10%)	0.78 (0.26–2.27)	0.656
Blood transfusion	52 (30%)	19 (46%)	0.66 (0.44–0.98)	0.055
Clinical late-onset sepsis	38 (22%)	8 (19%)	1.14 (0.57–2.26)	0.693
PIVH of any grade	84 (49%)	25 (60%)	0.81 (0.60–1.08)	0.183
PIVH III and IV	13 (8%)	7 (22%)	0.34 (0.16–0.75)	0.007
Periventricular leukomalacia	3 (1.8%)	2 (4.9%)	0.36 (0.06–2.09)	0.250
ROP	35 (20%)	12 (29%)	0.70 (0.40–1.23)	0.230
ROP requiring Laser	5(2.9%)	1 (2.4%)	1.20 (0.14–10)	0.670
Death	14 (8%)	5 (12%)	0.67 (0.25–1.76)	0.298

Patients	n	Cost (USD)						Days		Daily cost
		Resp.	Med.	Lab.	Exams	Daily hospital rate	Total	ICU	MR
Entire population	211	520	244	188	90	6618	8698	21	25	188
Survivors	192	494	226	183	92	7036	9065	21	17	238
Birth weight
<1000 g	33	1237	409	328	169	12,960	17,076	42	48	189
<1500 g	128	670	282	224	109	8618	11,189	27	33	186
GA
26–27 weeks	22	1609	612	427	196	14,855	20,150	59	45	193
28–29 weeks	48	735	362	236	117	9479	12,369	28	38	187
30 weeks	69	292	149	145	72	5596	7075	17	22	181
32 weeks	53	142	115	101	55	3819	4739	10	17	175

	Patients	n	Cost						Days
			Resp.	Med.	Lab	Exams	Daily	Total	ICU	ICN
All patients	With ACS	170	464	225	182	85	6258	8206	19	24
	Without ACS	41	748	321	231	111	8110	10,736	27	29
	Cost reduction		37%	30%	14%	23%	23%	23%	30%	17%
	p		0.087	0.047	0.190	0.427	0.512	0.638	0.07	0.148

Survivors	With ACS	156	423	199	173	84	6549	8383	19	26
	Without ACS	36	801	346	227	123	9149	12,023	31	33
	Cost reduction	47%	42%	24%	45%	28%	30%		38%	21%
	p		0.043	0.019	0.082	0.098	0.131	0.150	0.015	0.05

<1500 g	With ACS	104	562	240	207	98	7871	10,121	24	31
	Without ACS	24	1136	464	297	159	11,851	15,820	41	42
	Cost reduction	50%	48%	30%	38%	33%	36%		41%	26%
	p		0.005	0.004	0.005	0.006	0.009	0.008	0.122	0.021

<30 weeks	With ACS	55	792	328	261	120	9859	12,748	29	40
	Without ACS	14	1629	637	374	213	15,224	20,688	57	49
	Cost reduction	51%	48%	30%	43%	35%	38%		49%	18%
	p		0.011	0.182	0.071	0.002	0.007	0.008	0.011	0.105

>30 weeks	With ACS	100	217	128	96	64	4723	5962	14	19
	Without ACS	22	273	162	133	65	5283	6508	13	23
	Cost reduction	20%	20%	7%	2%	10%	8%		7%	17%
	p	0.317	0.044	0.349	0.675	0.714	0.775		0.899	0.317

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[TFN1] SGA, small for gestational age.

Costs of hospitalization in preterm infants: impact of antenatal steroid therapy☆ ☆☆

Costs of hospitalization in preterm infants: impact of antenatal steroid therapy^☆ ^{^☆☆}