title: Preterm birth in singleton and multiple pregnancies: evaluation of costs and perinatal outcomes.
abstract: OBJECTIVE
  To estimate costs of preterm birth in singleton and multiple pregnancies.
  
  
  METHODS
  Cost analysis based on data from a prospective cohort study and three multicentre randomised controlled trials (2006-2012) in a Dutch nationwide consortium for women's health research. Women with preterm birth before 37 completed weeks were included for analysis. Direct costs were estimated from a health care perspective, from delivery until discharge or decease of the neonates. Costs and adverse perinatal outcome per pregnancy were measured. Adverse perinatal outcome comprised both perinatal mortality and a composite of neonatal morbidity defined as chronic lung disease, intraventricular haemorrhage≥grade 2, periventricular leukomalacia≥grade 1, proven sepsis or necrotising enterocolitis. Using a moving average technique covering three weeks per measurement, costs and adverse perinatal outcome per woman delivering for every week between 24 and 37 weeks are reported.
  
  
  RESULTS
  Data of 2802 women were available of whom 1503 (53.6%) had a preterm birth; 501 in 1090 singleton (46%) and 1002 in 1712 multiple pregnancies (58.5%). The most frequent perinatal outcomes were perinatal mortality, chronic lung disease and sepsis. For singleton pregnancies the peak of total costs was at 25 weeks (€88,052 per delivery), compared to 27 weeks for multiple pregnancies (€169,571 per delivery). The total costs declined rapidly with increasing duration of pregnancy. Major cost drivers were length of stay on the NICU and airway treatments. The peaks seen in costs paralleled with the prevalence of adverse perinatal outcome.
  
  
  CONCLUSIONS
  These data can be used to elaborate on the impact of preterm birth in case only data are available on duration of pregnancy.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: g.j.vanbaaren@amc.nl.
authors.forename: Gert J
authors.initials: GJ
authors.lastname: van Baaren
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: m.j.peelen@amc.nl.
authors.forename: Myrthe J C S
authors.initials: MJ
authors.lastname: Peelen
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Ewoud
authors.initials: E
authors.lastname: Schuit
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Joris A M
authors.initials: JA
authors.lastname: van der Post
authors.affiliation: The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Australia.
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Kok
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Petra J
authors.initials: PJ
authors.lastname: Hajenius
mesh_terms: D002908:Chronic Disease; D003365:Costs and Cost Analysis; D004180:Direct Service Costs / Q000706:statistics & numerical data; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D007234:Infant, Premature; D020300:Intracranial Hemorrhages / Q000453:epidemiology; D007969:Leukomalacia, Periventricular / Q000453:epidemiology; D008171:Lung Diseases / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D054238:Perinatal Mortality; D011247:Pregnancy; D011272:Pregnancy, Multiple; D047928:Premature Birth / Q000191:economics* / Q000401:mortality; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000453:epidemiology
keywords: Costs; Multiple pregnancy; Perinatal morbidity; Perinatal mortality; Premature birth