Cost of clinician-driven tests and treatments in very low birth weight and/or very preterm infants

Abstract

Objective

To rank clinician-driven tests and treatments (CTTs) by their total cost during the birth hospitalization for preterm infants.

Study design

Retrospective cohort of very low birth weight (<1500 g) and/or very preterm (<32 weeks) subjects admitted to US children’s hospital Neonatal Intensive Care Units (2012–2018). CTTs were defined as pharmaceutical, laboratory and imaging services and ranked by total cost.

Results

24,099 infants from 51 hospitals were included. Parenteral nutrition ($85M, 32% of pharmacy costs), blood gas analysis ($34M, 29% of laboratory costs), and chest radiographs ($18M, 31% of imaging costs) were the costliest CTTs overall. More than half of CTT-related costs occurred during 10% of hospital days.

Conclusions

The majority of CTT-related costs were from commonly used tests and treatments. Targeted efforts to improve value in neonatal care may benefit most from focusing on reducing unnecessary utilization of common tests and treatments, rather than infrequently used ones.

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References

  1. 1.

    Keren R, Luan X, Localio R, Hall M, McLeod L, Dai D, et al. Prioritization of comparative effectiveness research topics in hospital pediatrics. Arch Pediatr Adolesc Med. 2012;166:1155–64.

    Article  PubMed  Google Scholar 

  2. 2.

    Dukhovny D, Pursley DM, Kirpalani HM, Horbar JH, Zupancic JA. Evidence, quality, and waste: solving the value equation in neonatology. Pediatrics. 2016;137:e20150312.

    Article  PubMed  Google Scholar 

  3. 3.

    Ho T, Zupancic JAF, Pursley DM, Dukhovny D. Improving value in neonatal intensive care. Clin Perinatol. 2017;44:617–25.

    Article  PubMed  Google Scholar 

  4. 4.

    Porter ME. What is value in health care? N Engl J Med. 2010;363:2477–81.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Wei D, Osman C, Dukhovny D, Romley J, Hall M, Chin S, et al. Cost consciousness among physicians in the neonatal intensive care unit. J Perinatol. 2016;36:1014–20.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Ho T, Dukhovny D, Zupancic JA, Goldmann DA, Horbar JD, Pursley DM. Choosing wisely in newborn medicine: five opportunities to increase value. Pediatrics. 2015;136:e482–9.

    Article  PubMed  Google Scholar 

  7. 7.

    Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Shwartz M, Young DW, Siegrist R. The ratio of costs to charges: how good a basis for estimating costs? Inquiry. 1995;32:476–81.

    PubMed  Google Scholar 

  9. 9.

    Finkler SA. The distinction between cost and charges. Ann Intern Med. 1982;96:102–9.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Dunn A, Grosse SD, Zuvekas SH. Adjusting health expenditures for inflation: a review of measures for health services research in the United States. Health Serv Res. 2018;53:175–96.

    Article  PubMed  Google Scholar 

  11. 11.

    Rao JNK, Scott AJ. The analysis of categorical data from complex sample surveys: Chi-squared tests for goodness of fit and independence in two-way tables. J Am Stat Assoc. 1981;76:221–30.

    Article  Google Scholar 

  12. 12.

    Richardson DK, Zupancic JA, Escobar GJ, Ogino M, Pursley DM, Mugford M. A critical review of cost reduction in neonatal intensive care. II. Strategies for reduction. J Perinatol. 2001;21:121–7.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Arjaans S, Zwart EAH, Ploegstra MJ, Bos AF, Kooi EMW, Hillege HL, et al. Identification of gaps in the current knowledge on pulmonary hypertension in extremely preterm infants: a systematic review and meta-analysis. Paediatr Perinat Epidemiol. 2018;32:258–67.

    Article  PubMed  Google Scholar 

  14. 14.

    Sankar MN, Bhombal S, Benitz WE. PDA: To treat or not to treat. Congenit Heart Dis. 2019;14:46–51.

    Article  PubMed  Google Scholar 

  15. 15.

    Suresh G, King BC, Jain SK. Screening for pulmonary hypertension in preterm infants-not ready for prime time. J Perinatol. 2018;38:206–10.

    Article  PubMed  Google Scholar 

  16. 16.

    Barrington KJ, Finer N, Pennaforte T. Inhaled nitric oxide for respiratory failure in preterm infants. Cochrane Database Syst Rev. 2017;1:CD000509.

    PubMed  Google Scholar 

  17. 17.

    Soll RF. Inhaled nitric oxide for preterm infants: what can change our practice? Pediatrics. 2018;141;e20174214.

    Article  PubMed  Google Scholar 

  18. 18.

    Kelly LE, Ohlsson A, Shah PS. Sildenafil for pulmonary hypertension in neonates. Cochrane Database Syst Rev. 2017;8:CD005494.

    PubMed  Google Scholar 

  19. 19.

    Ng G, Da Silva O, Ohlsson A. Bronchodilators for the prevention and treatment of chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2016;12:CD003214.

    PubMed  Google Scholar 

  20. 20.

    Stewart A, Brion LP. Intravenous or enteral loop diuretics for preterm infants with (or developing) chronic lung disease. Cochrane Database Syst Rev. 2011;9:CD001453.

    Google Scholar 

  21. 21.

    Goodman DC, Ganduglia-Cazaban C, Franzini L, Stukel TA, Wasserman JR, Murphy MA, et al. Neonatal intensive care variation in medicaid-insured newborns: a population-based study. J Pediatr. 2019;209:44–51.e2.

    Article  PubMed  Google Scholar 

  22. 22.

    Kaplan HC, Tabangin ME, McClendon D, Meinzen-Derr J, Margolis PA, Donovan EF. Understanding variation in vitamin A supplementation among NICUs. Pediatrics. 2010;126:e367–73.

    Article  PubMed  Google Scholar 

  23. 23.

    Slaughter JL, Stenger MR, Reagan PB. Variation in the use of diuretic therapy for infants with bronchopulmonary dysplasia. Pediatrics. 2013;131:716–23.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Slaughter JL, Stenger MR, Reagan PB, Jadcherla SR. Utilization of inhaled corticosteroids for infants with bronchopulmonary dysplasia. PLoS ONE. 2014;9:e106838.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Stenger MR, Slaughter JL, Kelleher K, Shepherd EG, Klebanoff MA, Reagan P, et al. Hospital variation in nitric oxide use for premature infants. Pediatrics. 2012;129:e945–51.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Rogowski J. Using economic information in a quality improvement collaborative. Pediatrics. 2003;111:e411–8.

    PubMed  Google Scholar 

  27. 27.

    Synhorst DC, Johnson MB, Bettenhausen JL, Kyler KE, Richardson TE, Mann KJ, et al. Room costs for common pediatric hospitalizations and cost-reducing quality initiatives. Pediatrics. 2020;145:e20192177.

    Article  PubMed  Google Scholar 

  28. 28.

    Phibbs CS, Schmitt SK, Cooper M, Gould JB, Lee HC, Profit J, et al. Birth hospitalization costs and days of care for mothers and neonates in California, 2009-2011. J Pediatr. 2019;204:118–25.e14.

    Article  PubMed  Google Scholar 

  29. 29.

    Russell RB, Green NS, Steiner CA, Meikle S, Howse JL, Poschman K, et al. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics. 2007;120:e1–9.

    Article  PubMed  Google Scholar 

  30. 30.

    Zupancic JA, Hibbs AM, Palermo L, Truog WE, Cnaan A, Black DM, et al. Economic evaluation of inhaled nitric oxide in preterm infants undergoing mechanical ventilation. Pediatrics. 2009;124:1325–32.

    Article  PubMed  Google Scholar 

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Conceptualization/design/methodology and Manuscript editing: BCK, TR, MH, NAB, HCL, KSG, JLS, RMP, SWP. Investigation/formal analysis and Manuscript drafting: BCK, TR, JLS. All authors gave final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

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Correspondence to Brian C. King.

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The authors declare that they have no conflict of interest.

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King, B.C., Richardson, T., Patel, R.M. et al. Cost of clinician-driven tests and treatments in very low birth weight and/or very preterm infants. J Perinatol (2020). https://doi.org/10.1038/s41372-020-00879-6

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