Postpartum length of stay and newborn health: a cost-effectiveness analysis.
OBJECTIVE
To evaluate the cost-effectiveness of increasing lengths of brief postpartum hospitalizations.


METHODS
A cost-effectiveness model extrapolating from secondary data was used. Social costs in 2000 US dollars were estimated using several sources, including a randomized controlled trial, a retrospective study, and survey data. Life-years saved from reduced infant mortality were estimated from administrative data from Washington State. A total of 113147 singleton newborns who were born in nonmilitary hospitals in Washington State in 1989 or 1990 and had postpartum stays short enough to be affected by length of stay legislation were studied. The cost-effectiveness of increases in postpartum lengths of stay similar to those that would occur if all mothers and singleton newborns used at least the time allotted to them under the federal length of stay legislation was measured.


RESULTS
Estimated lower-bound cost per newborn life-year saved was 19 800 dollars (95% confidence interval: 11600-61300 dollars) when only neonatal deaths were considered. The corresponding upper-bound estimate was 94800 dollars (95% confidence interval: 55200-286800 dollars ). The results were very sensitive to assumptions about the discount rate for future life-years and the time from birth during which averted deaths are considered (neonatal deaths, postneonatal infant deaths, or all infant deaths).


CONCLUSIONS
At hospitals that do not experience additional capacity costs as a result of increased lengths of stay, lengthening short postpartum stays seems to be more cost-effective than many common health interventions and well below cost-effectiveness thresholds suggested by the literature. Even at hospitals that experience additional capacity costs, the cost-effectiveness of lengthening short postpartum stays seems to be roughly equal to the benchmark of 100000 dollars per quality-adjusted life-year suggested by the literature.
Malkin
Jesse D
JD
RAND, Arlington, Virginia 22202-5050, USA. malkin@rand.org
Keeler
Emmett
E
Broder
Michael S
MS
Garber
Steven
S
D000367:Age Factors; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis / Q000379:methods / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends*; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data; D049590:Postpartum Period; D011247:Pregnancy; D017678:Sex Distribution; D012959:Socioeconomic Factors