Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: II. Efficiency

Abstract

Context: Although the increasing effectiveness of neonatal programs for extremely low birth weight (ELBW, birth weight <1000 g) infants has been established from cohort studies, there is a paucity of data on the relationship between the costs and the consequences of neonatal intensive care.

Objective: To determine the changes in the efficiency of neonatal intensive care for ELBW infants in Victoria, Australia over 2 decades.

Design: Economic evaluation (cost-effectiveness and cost-utility analyses) in a population-based cohort study of consecutive ELBW infants born during 4 distinct eras (1979-1980, 1985-1987, 1991-1992, and 1997) followed to at least 2 years of age.

Setting: The state of Victoria.

Patients: All ELBW live births of birth weight 500 to 999 g in the state in the calendar years indicated (1979-1980: n = 351; 1985-1987: n = 560; 1991-1992: n = 429; 1997: n = 233).

Main outcome measures: Costs were assessed primarily by the consumption of hospital resources. The consequences included survival and quality-adjusted survival rates at 2 years of age.

Results: The cost-effectiveness ratios (expressed in Australian dollars for 1997) were similar between successive eras at 5270 dollars, 3130 dollars, and 4050 dollars per life-year gained, respectively. The cost-utility ratios were similar between successive eras at 5270 dollars, 3690 dollars, and 5850 dollars per quality-adjusted life-year gained, respectively, and were similar to the cost-effectiveness ratios. The cost-effectiveness and cost-utility ratios were generally higher in lower birth-weight subgroups, but there were consistent gains in efficiency over time in infants of lower birth weight.

Conclusions: As there have been large increases in effectiveness from the late 1970s to the late 1990s, the efficiency of neonatal intensive care for ELBW infants in Victoria has remained relatively stable.