Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico

English version České info

Background:
Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico.

Methods and Findings:
A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24–26, 27–29, and 30–33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24–26, 27–29, and 30–33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses.

Conclusions:
Incremental cost-effectiveness ratios for neonatal intensive care imply very high value for money on the basis of conventional benchmarks for cost-effectiveness analysis.

: Please see later in the article for the Editors' Summary

Vyšlo v časopise: Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico. PLoS Med 7(12): e32767. doi:10.1371/journal.pmed.1000379
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1000379

Souhrn

Zdroje

1. RichardsonDK

GrayJE

GortmakerSL

GoldmannDA

PursleyDM

1998 Declining severity adjusted mortality: evidence of improving neonatal intensive care. Pediatrics 102 893 899

2. DoyleLW

2004 Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: I. Effectiveness. Pediatrics 113 505 509

3. ShanmugasundaramR

PadmapriyaE

ShyamalaJ

1998 Cost of neonatal intensive care. Indian J Pediatr 65 249 255

4. ZupancicJA

RichardsonDK

LeeK

McCormickMC

2000 Economics of prematurity in the era of managed care. Clin Perinatol 27 483 497

5. DoyleLW

2004 Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: II. Efficiency. Pediatrics 113 510 514

6. RogowskiJ

1998 Cost-effectiveness of care for very low birth weight infants. Pediatrics 102 35 43

7. SaigalS

BurrowsE

StoskopfBL

RosenbaumPL

StreinerD

2000 Impact of extreme prematurity on families of adolescent children. J Pediatr 137 701 706

8. WatsonRS

2003 Prematurity-associated costs: more than just surfactant. Pediatr Crit Care Med 4 256 257

9. XuK

EvansDB

KawabataK

ZeramdiniR

KlavusJ

2003 Household catastrophic health expenditure: a multicountry analysis. Lancet 362 111 117

10. VohrBR

WrightLL

DusickAM

MeleL

VerterJ

2000 Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. Pediatrics 105 1216 1226

11. StraughnHK

GoldenbergRL

TolosaJE

DalyS

de CodesJ

2003 Birthweight-specific neonatal mortality in developing countries and obstetric practices. Int J Gynaecol Obstet 80 71 78

12. FrenkJ

Gonzalez-PierE

Gomez-DantesO

LezanaMA

KnaulFM

2006 Comprehensive reform to improve health system performance in Mexico. Lancet 368 1524 1534

13. Gonzalez-PierE

Gutierrez-DelgadoC

StevensG

Barraza-LlorensM

Porras-CondeyR

2006 Priority setting for health interventions in Mexico's System of Social Protection in Health. Lancet 368 1608 1618

14. Tan-Torres EdejerT

BaltussenRM

AdamT

HutubessyR

AcharyaA

2003 Making choices in health: WHO guide to cost-effectiveness analysis. Geneva, Switzerland World Health Organization 312

15. KramerMS

PlattRW

WenSW

JosephKS

AllenA

2001 A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 108 e35

16. Ceron-MirelesP

HarlowSD

Sanchez-CarrilloCI

1996 The risk of prematurity and small-for-gestational-age birth in Mexico City: the effects of working conditions and antenatal leave. Am J Public Health 86 825 831

17. LeeKS

KimBI

KhoshnoodB

HsiehHL

ChenTJ

1995 Outcome of very low birth weight infants in industrialized countries: 1947–1987. Am J Epidemiol 141 1188 1193

18. ChaseHC

1972 A study of infant mortality from linked records: comparison of neonatal mortality from two cohort studies. Rockville (Maryland) US Department of Health, Education and Welfare. National Center for Health Statistics (HSM) 72 1056

19. Consejo Nacional de Población Proyecciones de la población de México 2005–2050 Available: http://www.conapo.gob.mx/. Accessed 19 October 2010

20. SingerRB

StraussD

ShavelleR

1998 Comparative mortality in cerebral palsy patients in California, 1980–1996. J Insur Med 30 240 246

21. StraussD

EymanRK

1996 Mortality of people with mental retardation in California with and without Down syndrome, 1986–1991. Am J Ment Retard 100 643 653

22. EscobarGJ

LittenbergB

PetittiDB

1991 Outcome among surviving very low birthweight infants: a meta-analysis. Arch Dis Child 66 204 211

23. LorenzJM

WoolieverDE

JettonJR

PanethN

1998 A quantitative review of mortality and developmental disability in extremely premature newborns. Arch Pediatr Adolesc Med 152 425 435

24. LorenzJM

2001 The outcome of extreme prematurity. Semin Perinatol 25 348 359

25. RobertsG

AndersonPJ

DoyleLW

Victorian Infant Collaborative Study Group 2009 Neurosensory disabilities at school age in geographic cohorts of extremely low birth weight children born between the 1970s and the 1990s. J Pediatr 154 829 834

26. SaigalS

DoyleLW

2008 An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 371 261 269

27. CarrollAE

DownsSM

2009 Improving decision analyses: parent preferences (utility values) for pediatric health outcomes. J Pediatr 155 21 25, 25

28. World Health Organization CHOosing Interventions that are Cost-Effective (WHO-CHOICE). Health State Valuations. Available: http://who.int/choice/demography/health_valuations/en/index.html. Accessed 19 October 2010

29. LemonsJA

BauerCR

OhW

KoronesSB

PapileLA

2001 Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 through December 1996. NICHD Neonatal Research Network. Pediatrics 107 e1

30. LeeSK

McMillanDD

OhlssonA

PendrayM

SynnesA

2000 Variations in practice and outcomes of the Canadian NICU Network 1996–7. Pediatrics 106 1070 1079

31. AdamT

EvansDB

MurrayCJ

2003 Econometric estimation of country-specific hospital costs. Cost Eff Resour Alloc 1 3

32. ZupancicJA

RichardsonDK

2002 Characterization of neonatal personnel time inputs and prediction from clinical variables—a time and motion study. J Perinatol 22 658 663

33. YostCC

SollRF

2000 Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev CD001456

34. Osiris Collaborative Group 1992 Early versus delayed neonatal administration of a synthetic surfactant—the judgment of OSIRIS. Lancet 340 1363 1369

35. EscobarGJ

McCormickMC

ZupancicJAF

Coleman-PhoxK

ArmstrongMA

2006 Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit. Arch Dis Child - Fetal and Neonatal Edition 91 F238 F244

36. NagataE

BritoAS

MatsuoT

2002 Nosocomial infections in a neonatal intensive care unit: incidence and risk factors. Am J Infect Control 30 26 31

37. Pessoa-SilvaCL

RichtmannR

CalilR

SantosRM

CostaML

2004 Healthcare-associated infections among neonates in Brazil. Infect Control Hosp Epidemiol 25 772 777

38. PayneNR

CarpenterJH

BadgerGJ

HorbarJD

RogowskiJ

2004 Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants. Pediatrics 114 348 355

39. UnderwoodMA

DanielsenB

GilbertWM

2007 Cost, causes and rates of rehospitalization of preterm infants. J Perinatol 27 614 619

40. HoneycuttA

DunlapL

ChenH

Al HomsiG

2000 The cost of developmental disabilities. Research Triangle Park (North Carolina) Research Triangle Institute

41. HoneycuttAA

GrosseSD

DunlapLJ

SchedelDE

ChenH

2003 Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment.

AltmanB

BarnarttS

HedershotG

LarsonS

Using survey data to study disability: results from the National Health Interview Survey on disability London Elsevier 207 228

42. HutubessyR

ChisholmD

EdejerT

for W-C 2003 Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc 1 8

43. DoubiletP

BeggCB

WeinsteinMC

BraunP

McNeilBJ

1985 Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach. Med Decis Making 5 157 177

44. World Bank Data. Indicators. GDP per capita (current US$). Available: http://data.worldbank.org/indicator/NY.GDP.PCAP.CD. Accessed 19 October 2010

45. UNICEF Millenium Development Goals. Available: www.unicef.org/mdg. Accessed 19 October 2010

46. LawnJE

CousensS

DarmstadtGL

PaulV

MartinesJ

2004 Why are 4 million newborn babies dying every year? Lancet 364 2020

47. DarmstadtGL

BhuttaZA

CousensS

AdamT

WalkerN

2005 Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 365 977 988

48. NarendranV

DonovanEF

HoathSB

AkinbiHT

SteichenJJ

2003 Early bubble CPAP and outcomes in ELBW preterm infants. J Perinatol 23 195 199

49. KoyamaiboleL

KadoJ

QovuJD

ColquhounS

DukeT

2006 An evaluation of bubble-CPAP in a neonatal unit in a developing country: effective respiratory support that can be applied by nurses. Journal of Tropical Pediatrics 52 249 253

50. LawnJE

Mwansa-KambafwileJ

HortaBL

BarrosFC

CousensS

2010 ‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications. Int J Epidemiol 39 Suppl 1 i144 i154

51. AskieLM

Henderson-SmartDJ

KoH

2009 Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants. Cochrane Database Syst Rev CD001077

52. MoralesY

SchanlerRJ

2007 Human milk and clinical outcomes in VLBW infants: how compelling is the evidence of benefit? Semin Perinatol 31 83 88

53. SollRF

2008 Heat loss prevention in neonates. J Perinatol 28 Suppl 1 S57 S59

54. SaigalS

StoskopfB

BoyleM

PanethN

PinelliJ

2007 Comparison of current health, functional limitations, and health care use of young adults who were born with extremely low birth weight and normal birth weight. Pediatrics 119 e562 e573

55. SaigalS

StreinerD

2009 Socio-economic achievements of individuals born very preterm at the age of 27 to 29 years. Dev Med Child Neurol 51 848 850

56. SaigalS

StoskopfBL

FeenyD

FurlongW

BurrowsE

1999 Differences in preferences for neonatal outcomes among health care professionals, parents, and adolescents. JAMA 281 1991 1997

57. VerripsE

VogelsT

SaigalS

WolkeD

MeyerR

2008 Health-related quality of life for extremely low birth weight adolescents in Canada, Germany, and the Netherlands. Pediatrics 122 556 561

58. CutlerDM

McClellanM

2001 Is technological change in medicine worth it? Health Affairs 20 11 29

59. CheahIGS

SoosaiAP

WongSL

LimTO

2004 Cost-effectiveness analysis of Malaysian neonatal intensive care units. J Perinatol 25 47 53

60. International Monetary Fund GDP, deflator. Available: http://www.econstats.com/weo/V005.htm. Accessed 19 October 2010

61. GilbertC

RahiJ

EcksteinM

O'SullivanJ

FosterA

1997 Retinopathy of prematurity in middle-income countries. Lancet 350 12 14

62. GilbertC

FielderA

GordilloL

QuinnG

SemigliaR

2005 Characteristics of infants with severe retinopathy of prematurity in countries with low, moderate, and high levels of development: implications for screening programs. Pediatrics 115 e518 e525

63. World Health Organization WHO Director-General's Roundtable with Women Leaders on Millennium Development Goal 5. Country Profiles. Mexico. Available: http://www.who.int/making_pregnancy_safer/events/2008/mdg5/countries/cp_mexico_19_09_09.pdf. Accessed 19 October 2010

64. RiosJM

Tufino-OlivaresE

Reza-LopezS

SaninLH

Levario-CarrilloM

2008 Birthweight percentiles by gestational age and gender for children in the North of Mexico. Paediatr Perinat Epidemiol 22 188 194

65. LozanoR

SolizP

GakidouE

bbott-KlafterJ

FeehanDM

2006 Benchmarking of performance of Mexican states with effective coverage. Lancet 368 1729 1741