title: PERFECT preterm infant study.
abstract: BACKGROUND
  This article summarizes the main findings of the preterm infant sub-study of the Performance, Effectiveness and Costs of Treatment episodes (PERFECT) study. We studied effects of birth hospital level and time of birth on mortality and morbidity and cost-effectiveness of care of very low gestational age (VLGA)/very low birth weight (VLBW) infants.
  
  
  METHODS
  The study included all infants born below 32 weeks or 1501 g in Finland in 2000-2007. Different cohorts were used depending on the time point.
  
  
  RESULTS
  The one-year mortality of live-born VLBW/VLGA infants was higher if born in level II versus level III hospitals, or if born during out-of-office hours in level II versus office hours in level III hospitals. Two out of three VLGA/VLBW subjects did not have any of the prematurity-related morbidities studied. The average cost of quality-adjusted life years was €19,245 by four years of age; the cost was higher in VLGA/VLBW infants with long-term morbidities.
  
  
  CONCLUSIONS
  Birth in a level III hospital improved survival of VLGA/VLBW infants. Results suggest inadequate overnight competence in small hospitals. Despite high initial costs, care of VLGA/VLBW infants was already cost-effective by four years of age. Cost-effectiveness can be improved by reducing long-term morbidities.
authors.affiliation: Department of Paediatrics, Turku University Hospital, Turku, Finland. liisa.lehtonen@utu.fi
authors.forename: Liisa
authors.initials: L
authors.lastname: Lehtonen
authors.forename: Liisi
authors.initials: L
authors.lastname: Rautava
authors.forename: Emmi
authors.initials: E
authors.lastname: Korvenranta
authors.forename: Heikki
authors.initials: H
authors.lastname: Korvenranta
authors.forename: Mikko
authors.initials: M
authors.lastname: Peltola
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
mesh_terms: D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D009017:Morbidity; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D047928:Premature Birth / Q000191:economics / Q000453:epidemiology*; D019057:Quality-Adjusted Life Years