title: Resuscitation of likely nonviable infants: a cost-utility analysis after the Born-Alive Infant Protection Act.
abstract: OBJECTIVE
  The purpose of this study was to compare the effects of universal vs selective resuscitation on maternal utilities, perinatal costs, and outcomes of preterm delivery and termination of pregnancy at 20-23 weeks 6 days' gestation.
  
  
  METHODS
  We used studies on medical practices, prematurity outcomes, costs, and maternal utilities to construct decision-analytic models for a cohort of annual US deliveries after preterm delivery or induced termination. Outcome measures were (1) the numbers of infants who survived intact or with mild, moderate, or severe sequelae; (2) maternal quality-adjusted life years (QALYs); and (3) incremental cost-effectiveness ratios.
  
  
  RESULTS
  Universal resuscitation of spontaneously delivered infants between 20-23 weeks 6 days' gestation increases costs by $313.1 million and decreases QALYs by 329.3 QALYs; after a termination, universal resuscitation increases costs by $15.6 million and decreases QALYs by 19.2 QALYs. With universal resuscitation, 153 more infants survive: 44 infants are intact or mildly affected; 36 infants are moderately impaired, and 73 infants are severely disabled.
  
  
  CONCLUSIONS
  Selective intervention constitutes the highest utility and least costly treatment for infants at the margin of viability.
authors: Division of Neonatology, Department of Pediatrics, University of California, School of Medicine, San Francisco, USA.
authors: John Colin
authors: JC
authors: Partridge
authors: Mya D
authors: MD
authors: Sendowski
authors: Alma M
authors: AM
authors: Martinez
authors: Aaron B
authors: AB
authors: Caughey
mesh_terms: D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000191:economics* / Q000331:legislation & jurisprudence*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012151:Resuscitation / Q000191:economics*; D012720:Severity of Illness Index; D016896:Treatment Outcome