title: Estimating community-level costs of preterm birth.
abstract: OBJECTIVE
  To develop generalizable methods for estimating the economic impact of preterm birth at the community level on initial hospital expenditures, educational attainment and lost earnings as well as to estimate potential savings associated with reductions in preterm birth.
  
  
  METHODS
  The retrospective, population-based analysis used vital statistics and population demographics from Hamilton County, Ohio, USA, in 2012.
  
  
  METHODS
  We adjusted previously reported, mean initial hospital cost estimates (stratified by each week of gestation) to 2012 dollars using national cost-to-charge ratios. Next, we calculated excess costs attributable to prematurity and potential hospital cost savings, which could be realized by prolonging each preterm pregnancy by a single week of gestation. Using reported associations among preterm birth, educational attainment and adult earnings, we developed generalizable formulas to calculate lost academic degrees and lost income estimates attributable to preterm birth. The formulas generated estimates based on local population demographics.
  
  
  RESULTS
  The annual initial hospital cost associated with 1444 preterm infants was estimated at $93 million. In addition, over 9000 fewer college degrees and over $300 million in lost annual earnings were attributed to local adults who were born preterm. Prolonging each preterm birth by 1 week could potentially reduce initial hospital expenditures by over $25 million. Additional potential savings could be realized as healthier infants attain higher levels of education and earnings as adults.
  
  
  CONCLUSIONS
  The generalizable methods developed for estimating the economic impact of preterm birth at the community level can be used by any community in which vital statistics and population demographics are available. Cost estimates can serve to rally support for local stakeholder investment in developing strategies for preterm birth intervention leading to improved pregnancy outcomes.
authors.affiliation: Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Cradle Cincinnati, Cincinnati, OH, USA. Electronic address: eric.hall@cchmc.org.
authors.forename: E S
authors.initials: ES
authors.lastname: Hall
authors.affiliation: Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Cradle Cincinnati, Cincinnati, OH, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Greenberg
mesh_terms: D000328:Adult; D017046:Cost Savings / Q000706:statistics & numerical data; D017281:Cost of Illness; D004522:Educational Status; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007231:Infant, Newborn; D007234:Infant, Premature; D009820:Ohio; D011247:Pregnancy; D047928:Premature Birth / Q000191:economics* / Q000517:prevention & control; D012189:Retrospective Studies
keywords: Cost analysis; Gestational age; Health expenditures; Hospital costs; Infant; Newborn; Premature birth; Vital statistics