Healthcare Cost Savings to the Health System From Delaying Preterm Birth by Weeks in the Northern Territory, Australia: A Population-Based Study
Author(s)
Tsegaye G. Haile, MSc, MPH, PhD Candidate, Gavin Pereira, PhD, Richard Norman, BA, MSc, PhD, Gizachew Tessema, MPH, PhD.
Curtin School of Population Health, Curtin University, Perth, Australia.
Curtin School of Population Health, Curtin University, Perth, Australia.
OBJECTIVES: Survival following preterm birth (PTB) has improved in recent decades, yet associated short- and long-term complications continue to place a substantial burden on health systems. Emerging evidence suggests that even modest prolongation of gestation, by as little as one week, can reduce adverse outcomes and healthcare costs. We estimated the incremental cost savings to the healthcare system associated with delaying PTB by weeks during early childhood in the Northern Territory, Australia.
METHODS: A retrospective cohort study included singleton live births recorded from July 1, 2000, to June 30, 2016. Linked hospitalisation and emergency department (ED) records up to June 30, 2021, were available for 31,169 and 42,139 children, respectively. Costs were calculated from a health system perspective, standardised to June 2024 Australian dollars (AUD), and included hospital admissions and ED presentations from birth to age five years. A generalised additive model (gamma distribution, log link) was fitted with covariates selected via least absolute shrinkage and selection operator (LASSO) regression.
RESULTS: Delaying birth by one week was associated with substantial reductions in healthcare costs. Median per-child hospitalisation savings ranged from AUD 58,412 at 23 weeks to AUD 2,491 at 36 weeks of gestation. Corresponding ED savings ranged from AUD 11,343 to AUD 373. The greatest per-child savings were observed when delaying birth from 23 to 24 weeks. Transitioning from extremely preterm (23-27 weeks) to very preterm (28-32 weeks) gestation yielded mean savings of AUD 43,946 (95% CI: 33,869-54,023) for hospitalisations and AUD 1,522 (95% CI: 62-2,983) for ED care. Costs were non-linearly associated with gestational age and other factors, including maternal age and hospital stay duration.
CONCLUSIONS: While per-birth savings were largest at earlier gestations, greater overall system-level savings were observed among late PTB due to their higher frequency. These findings underscore the importance of strategies to prevent or delay PTB across gestational ages.
METHODS: A retrospective cohort study included singleton live births recorded from July 1, 2000, to June 30, 2016. Linked hospitalisation and emergency department (ED) records up to June 30, 2021, were available for 31,169 and 42,139 children, respectively. Costs were calculated from a health system perspective, standardised to June 2024 Australian dollars (AUD), and included hospital admissions and ED presentations from birth to age five years. A generalised additive model (gamma distribution, log link) was fitted with covariates selected via least absolute shrinkage and selection operator (LASSO) regression.
RESULTS: Delaying birth by one week was associated with substantial reductions in healthcare costs. Median per-child hospitalisation savings ranged from AUD 58,412 at 23 weeks to AUD 2,491 at 36 weeks of gestation. Corresponding ED savings ranged from AUD 11,343 to AUD 373. The greatest per-child savings were observed when delaying birth from 23 to 24 weeks. Transitioning from extremely preterm (23-27 weeks) to very preterm (28-32 weeks) gestation yielded mean savings of AUD 43,946 (95% CI: 33,869-54,023) for hospitalisations and AUD 1,522 (95% CI: 62-2,983) for ED care. Costs were non-linearly associated with gestational age and other factors, including maternal age and hospital stay duration.
CONCLUSIONS: While per-birth savings were largest at earlier gestations, greater overall system-level savings were observed among late PTB due to their higher frequency. These findings underscore the importance of strategies to prevent or delay PTB across gestational ages.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE499
Topic
Clinical Outcomes, Economic Evaluation, Epidemiology & Public Health
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Pediatrics