Cost of preterm birth during initial hospitalization: A care providers perspective

Abstract

Preterm birth incidence has risen globally and remains a major cause of neonatal mortality despite improved survival. The demand and cost of initial hospitalization has also increased. This study assessed care provider cost in neonatal intensive care units of two hospitals in the state of Kedah, Malaysia. It utilized universal sampling and prospectively followed up preterm infants till discharge. Care provider cost was assessed using mixed method of top down approach and activity based costing. A total of 112 preterm infants were recruited from intensive care (93 infants) and minimal care (19 infants). Majority were from the moderate (23%) and late (36%) preterm groups followed by very preterm (32%) and extreme preterm (9%). Mean total cost per infant increased with level of care and degree of prematurity from MYR 2,751 (MYR 374 - MYR 10,103) for preterm minimal care, MYR 8,478 (MYR 817 - MYR 47,354) for late preterm intensive care to MYR 41,598 (MYR 25,351- MYR 58,828) for extreme preterm intensive care. Mean cost per infant per day increased from MYR 401 (MYR 363- MYR 534), MYR 444 (MYR 354 - MYR 916) to MYR 532 (MYR 443-MYR 939) respectively. Cost was dominated by overhead (fixed) costs for general (hospital), intermediate (clinical support services) and final (NICU) cost centers where it constituted at least three quarters of mean admission cost per infant while the remainder was consumables (variable) costs. Breakdown of overhead cost showed NICU specific overhead contributing at least two thirds of mean admission cost per infant. Personnel salary made up three quarters of NICU specific overhead. Laboratory investigation was the cost driver for consumables ranging from 29% (intensive care) to 84% (minimal care) of mean total consumables cost per infant. Gender, birth weight and length of stay were significant factors and cost prediction was developed with these variables.