Direct medical costs of preterm birth from birth to age 7 years: a population-based study in Manitoba, Canada

Purpose (i) To determine direct medical costs by gestational age and survival status from birth to age 7 years in two cohorts (16,079 newborns in 1987 and 15,853 newborns in 1993) in Manitoba, Canada, and (ii) to determine the incremental costs associated with preterm birth. The 1993 cohort was chosen to examine the impact of surfactant on survival and costs. Methods A longitudinal population-based study using administrative data to calculate actual costs of hospital inpatient care (based on Refined Diagnostically Related Groups), physician and lab or diagnostic costs associated with hospital stays, and outpatient care, using 1995 constant dollars. Results Costs were inversely associated with gestational age. Substantial costs were associated with the initial hospital stay and first year of life; costs declined dramatically over the next 6 years. 1993 costs were generally lower except for infants 25 weeks old or younger. Incremental costs of preterm birth (1993 cohort) were $4.2 million (initial hospital stay), $734,000 (remainder year 1), and $651,000 (age 1–6) (Table 1). Specifically, for the two cohorts and five gestational age groups, mean direct costs for the first year of life and for years 1 to 6, respectively, were: ≤25 weeks, $70,994 and $6865 (1987 cohort) and $106,773 and $60,539 (1993 cohort); 26–28 weeks, $47,856 and $4399 (1987) and $39,196 and $4040 (1993); 29–32 weeks, $17,762 and $6590 (1987) and $12,687 and $2271 (1993); 33–36 weeks, $4866 and $2268 (1987) and $4650 and $1850 (1993); ≥37 weeks, $1700 and $1654 (1987) and $1389 and $1306 (1993). Conclusion Reducing the preterm birth rate or new interventions to increase gestational age at birth would result in significant cost savings. These costs estimates can be used for benchmarking and evaluation of new treatments