Preterm birth-associated cost of early intervention services: an analysis by gestational age.
OBJECTIVE
Characterizing the cost of preterm birth is important in assessing the impact of increasing prematurity rates and evaluating the cost-effectiveness of therapies to prevent preterm delivery. To assess early intervention costs that are associated with preterm births, we estimated the program cost of early intervention services for children who were born in Massachusetts, by gestational age at birth.


METHODS
Using the Pregnancy to Early Life Longitudinal Data Set, birth certificates for infants who were born in Massachusetts between July 1999 and June 2000 were linked to early intervention claims through 2003. We determined total program costs, in 2003 dollars, of early intervention and mean cost per surviving infant by gestational age. Costs by plurality, eligibility criteria, provider discipline, and annual costs for children's first 3 years also were examined.


RESULTS
Overall, 14,033 of 76,901 surviving infants received early intervention services. Program costs totaled almost $66 million, with mean cost per surviving infant of $857. Mean cost per infant was highest for children who were 24 to 31 weeks' gestational age ($5393) and higher for infants who were 32 to 36 weeks' gestational age ($1578) compared with those who were born at term ($725). Cost per surviving infant generally decreased with increasing gestational age. Among children in early intervention, mean cost per child was higher for preterm infants than for term infants. At each gestational age, mean cost per surviving infant was higher for multiples than for singletons, and annual early intervention costs were higher for toddlers than for infants.


CONCLUSIONS
Compared with their term counterparts, preterm infants incurred higher early intervention costs. This information along with data on birth trends will inform budget forecasting for early intervention programs. Costs that are associated with early childhood developmental services must be included when considering the long-term costs of prematurity.
Clements
Karen M
KM
Massachusetts Department of Public Health, Center for Community Health, 250 Washington St, 5th Floor, Boston, MA 02108, USA. karen.clements@state.ma.us
Barfield
Wanda D
WD
Ayadi
M Femi
MF
Wilber
Nancy
N
D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D018479:Early Intervention, Educational / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D017048:Health Care Costs; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D007363:Intensive Care Units, Neonatal / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts; D015999:Multivariate Analysis; D011181:Postnatal Care / Q000191:economics; D011247:Pregnancy; D047928:Premature Birth / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D011336:Probability; D012042:Registries; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors