title: Pushing the boundaries of viability: the economic impact of extreme preterm birth.
abstract: BACKGROUND
  Previous assessments of the economic impact of preterm birth focussed on short term health service costs across the broad spectrum of prematurity.
  
  
  OBJECTIVE
  To estimate the societal costs of extreme preterm birth during the sixth year after birth.
  
  
  METHODS
  Unit costs were applied to estimates of health, social and broader resource use made by 241 children born at 20 through 25 completed weeks of gestation in the United Kingdom and Republic of Ireland and a comparison group of 160 children born at full term. Societal costs per child during the sixth year after birth were estimated and subjected to a rigorous sensitivity analysis. The effects of gestational age at birth on annual societal costs were analysed, first in a simple linear regression and then in a multiple linear regression.
  
  
  RESULTS
  Mean societal costs over the 12 month period were 9541 pounds sterling (standard deviation 11,678 pounds sterling) for the extreme preterm group and 3883 pounds sterling (1098 pounds sterling) for the term group, generating a mean cost difference of 5658 pounds sterling (bootstrap 95% confidence interval: 4203 pounds sterling, 7256 pounds sterling) that was statistically significant (P<0.001). After adjustment for clinical and sociodemographic covariates, sex-specific extreme preterm birth was a strong predictor of high societal costs.
  
  
  CONCLUSIONS
  The results of this study should facilitate the effective planning of services and may be used to inform the development of future economic evaluations of interventions aimed at preventing extreme preterm birth or alleviating its effects.
authors.affiliation: National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK. stavros.petrou@npeu.ox.ac.uk
authors.forename: Stavros
authors.initials: S
authors.lastname: Petrou
authors.forename: Jane
authors.initials: J
authors.lastname: Henderson
authors.forename: Melanie
authors.initials: M
authors.lastname: Bracewell
authors.forename: Christine
authors.initials: C
authors.lastname: Hockley
authors.forename: Dieter
authors.initials: D
authors.lastname: Wolke
authors.forename: Neil
authors.initials: N
authors.lastname: Marlow
mesh_terms: D015331:Cohort Studies; D003365:Costs and Cost Analysis; D003710:Demography; D005260:Female; D005865:Gestational Age; D015276:Health Care Rationing; D006801:Humans; D007231:Infant, Newborn; D007494:Ireland; D016014:Linear Models; D008297:Male; D011247:Pregnancy; D047928:Premature Birth / Q000191:economics*; D012959:Socioeconomic Factors; D006113:United Kingdom