369 - Costs of major neonatal morbidities among neonates born <29 weeks in Canada

Publication Number: 369.4419

Telford Yeung, University of Calgary, Calgary, AB, Canada; Asma M. Ahmed, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Marc Beltempo, McGill University Faculty of Medicine and Health Sciences, Monreal, PQ, Canada; Petros Pechlivanoglou, The Hospital For Sick Children, Toronto, ON, Canada; Prakesh S. Shah, Mount Sinai Hospital, Toronto, ON, Canada

Background: Preterm birth < 29 weeks is associated with an increased risk of neonatal morbidity and mortality. Data on direct hospital costs of each morbidity from the perspective of the public payor is lacking.

Objective: To describe the costs of NICU care for isolated major morbidities in neonates < 29 weeks’ gestation during the years 2010 to 2021.

Design/Methods: We conducted a retrospective analysis of infants born at < 29 weeks’ gestation admitted to sites in the Canadian Neonatal Network (CNN) between the years of 2010 and 2021. Patient details for late-onset sepsis (LOS), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD) and severe neurological injury (SNI) were retrieved from the CNN database. Infants with these morbidities in isolation were compared to survivors without major morbidity (SWMM) from the perspective of costs. Using a validated costing algorithm that assessed physician, nursing, respiratory therapy, diagnostic imaging, transfusions, procedural, medication and certain indirect costs, we calculated costs of isolated morbidities in and resource utilization adjusted to 2017 Canadian dollars using the Statistics Canada consumer price index.

Results: A total of 24,530 neonates were included, and their baseline characteristics are described in Table 1. Survival to NICU discharge was 88%. Among SWMM, mean (SD) total cost, cost per day and length of stay were $78,821 (49,104), $1,577 (455), and 53 (32) days; whereas the mean (SD) total cost for neonates with LOS, NEC, BPD and SNI were $103,330 (57,097), $79,746 (73,100), $127,891 (82,672) and $61,034 (51,202). Mean daily costs were the highest for NEC and SNI at $2,577 (1,629) and $2,570 (1,338), due to higher mortality and shorter mean length of stay. Mean daily costs of LOS and BPD were the lowest among the four morbidities due to the prolonged length of stay (Table 2). In addition, survivors had lower mean and median daily costs than non-survivors for each co-morbidity (Table 2 and Figure 1).

Conclusion(s): The presence of neonatal morbidities was associated with higher total costs for LOS and BPD. Due to differences in mortality between comorbidities, however, the costs per day were the greatest for NEC and SNI. Daily costs for survivors with morbidities were comparable to SWMM, but higher in non-survivors for all morbidities. These cost estimates describe the economic burden of neonatal morbidities in preterm birth, which can be utilized in cost-benefit analyses of contemporary and future interventions.

Table 1. Clinical Demographics of Neonates born Extremely Preterm in Canada
GA – Gestational age; SGA – Small for gestational age, < 3rd %ile; SNAP-II – The Score for Neonatal Acute Physiology-Version II
*The listed frequency of morbidities includes infants with only the specified morbidity (and no other)


Table 2: Inpatient costs and length of stay of major neonatal morbidities
Abbreviations: BPD – bronchopulmonary dysplasia, LOS – late onset sepsis, NEC – necrotizing enterocolitis, SNI – severe neurologic injury

Costs of neonatal morbidities according to survival status
Figure 1: Total (A) and daily costs (B) of each morbidity by survival status. The x-axis is the gestational age in weeks and the y-axis is the estimated median (IQR) cost. Abbreviations: BPD – bronchopulmonary dysplasia, CAD – Canadian dollar, IQR – interquartile range, LOS – late onset sepsis, NEC – necrotizing enterocolitis, SNI – severe neurologic injury, $K = ~$1000 CAD