Systematic review of the healthcare cost of bronchopulmonary dysplasia

Abstract

Objectives: To determine the costs directly or indirectly related to bronchopulmonary dysplasia (BPD) in preterm infants. The secondary objective was to stratify the costs based on gestational age and/or birth weight.

Design: Systematic literature review.

Setting: PubMed and Scopus were searched on 3 February 2020. Studies were selected based on eligibility criteria by two independent reviewers. Included studies were further searched to identify eligible references and citations.Two independent reviewers extracted data with a prespecified data extraction sheet, including items from a published checklist for quality assessment. The costs in the included studies are reported descriptively.

Primary outcome measure: Costs of BPD.

Results: The 13 included studies reported the total costs or marginal costs of BPD. Most studies reported costs during birth hospitalisation (cost range: Int$21 392-Int$1 094 509 per child, equivalent to €19 103-€977 397, in 2019) and/or during the first year of life. One study reported costs during the first 2 years; two other studies reported costs later, during the preschool period and one study included a long-term follow-up. The highest mean costs were associated with infants born at extremely low gestational ages. The quality assessment indicated a low risk of bias in the reported findings of included studies.

Conclusions: This study was the first systematic review of costs associated with BPD. We confirmed previous reports of high costs and described the long-term follow-up necessary for preterm infants with BPD, particularly infants of very low gestational age. Moreover, we identified a need for studies that estimate costs outside hospitals and after the first year of life.

Prospero registration number: CRD42020173234.

Keywords: chronic airways disease; health economics; paediatric thoracic medicine; paediatrics; respiratory medicine (see thoracic medicine).

Figure 1

Flow diagram shows the study selection process, following the PRISMA guidelines. BPD, bronchopulmonary dysplasia; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Overview of the costs of BPD and the study period included in each article. The numbers on the Y-axis refer to the numbers assigned to each study (table 1).

Figure 3

Costs of the index hospitalisations for preterm infants with BPD in studies conducted between 1981 and 2015. All costs were converted to Int$, based on purchasing power parities, then the values were inflated to 2019 values. abbreviations: BPD, bronchopulmonary dysplasia.

Figure 4

Mean cost increase for infants with BPD, stratified by gestational age (GA) at birth. The numbers on the x-axis refer to the numbers assigned to studies in table 1. BPD, bronchopulmonary dysplasia.