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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Terri Major-Kinkade, MD1, Luisa Franzini, PhD2, Jon Tyson, MD, MPH3, Katheleen Kennedy, MD, MPH3, and Michael Swint, PhD1. (1) University of Texas Health Science Center at Houston, 6431 Fannin Street Suite 3.600, Houston, TX 77030, (2) University of Texas School of Public Health, 1200 Herman Pressler, Houston, TX 77030, 713 500 9487, Terri.Major-Kincade@uth.tmc.edu, (3) Neonatology, University of Texas Health Science Center at Houston, 6431 Fannin Street Suite 3.600, Houston, TX 77030
Very few of neonatal therapies with the exception of surfactant, ECMO and erythropoetin have been evaluated with rigorous economic analyses. Chronic lung disease (CLD), a common complication in extremely low birth weight survivors, is likely to increase costs because of prolonged oxygen and ventilator therapy and prolonged hospital stays. Therapeutic interventions, which reduce the risk of chronic lung disease, might substantially reduce the cost of neonatal intensive care for treated infants. Eight hundred and seven infants with birth weight of 401-1000grams who received mechanical ventilation or supplemental oxygen at 24 hours of age at 14 NICHD sites over 18 months (January 1996-July 1997) were recruited. A dose of 5000IU of Vitamin A was given three times/week for four weeks to infants in the Vitamin A group. The primary outcome was a relative risk of 0.89 (95%: 0.80-0.99) CLD or death at 36 weeks postconceptual age in infants given Vitamin A, as compared to infants not receiving Vitamin A. Cost data were obtained from Parkland Memorial Hospital in Dallas, Good Samaritan Hospital, University Hospital and Childrens Hospital in Cincinnati. Hospital charge data for NICU day, blood, EKG, EEG, laboratory, medical supplies, observation room, pharmacy, physical therapy, radiology, respiratory therapy, speech and ultrasound cost centers were collected for each patient from itemized bills. For each infant, charges were multiplied by the appropriate department specific cost-to-charge ratio from each hospital's annual Medicare report and added to obtain a total cost per infant. Incremental costs associated with the administration of Vitamin A were estimated at $99.03 per infant treated. We used an incremental cost-effectiveness analysis to test whether Vitamin A supplementation increases survival without increasing hospital costs to nursery discharge for ELBW infants. The perspective is the hospital perspective as only hospital costs were included. Physician charges and costs to patients were excluded. For every 100 ELBW infants treated with vitamin A, there were six extra survivors without CLD. For every 100 ELBW infants treated with vitamin A, there was a cost saving of $713,300 in Dallas, $314,900 in Cincinnati, and $523,900 in the pooled dataset. The administration of Vitamin A to ELBW infants is compatible with an important economic benefit.
Learning Objectives: At the conclusion of the session, the participant will be able to
Keywords: Cost Issues, Child Health
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.