OBJECTIVES. Although, several publications describe the costs of managing premature or low birth-weight infants, these data are actually difficult to compare and synthetize due to heterogeneity of costing methods, duration of observational period, year of publication and health systems. The objective was to quantify the relative incremental costs of prematurity or low birth weight compared to full-term or normal birth weight infant.

METHODS. A systematic literature review was conducted to identify data sources. The average cost ratio of babies with prematurity or low birthweight categories versus mature or normal birth-weight infants was calculated based on 12 relevant publications from 11 countries.

RESULTS. Eight studies presented data for different gestational ages, 3 for different birth weights and 1 for both. Ten studies investigated only the direct medical costs. In the analyses of weekly gestational age, the ratios of costs ranged from 230 to 0.5 times between weeks 23 and 36 (compared to mature babies). In the analyses of gestational age ranges, extremely preterm infants generated 21 to 47 times higher costs than the full-term infants, while the very preterms had 9.6-28 times higher costs. The effects of moderate prematurity only led to an increase in the costs of 4.5-5.2 times. Very low and low birth weight resulted in moderate, 23 and 11 times increments. Dysmaturity itself resulted in additional costs, as well as the presence of major birth defects. Studies with over one year observational period showed that higher incremental cost ratios were experienced in early periods after birth for premature compared to mature infants, especially during the initial hospitalization.

CONCLUSIONS. Our systematic literature review demonstrated that medical care of premature infants requires considerably higher financial resources than care of their mature comparators, and each additional week of gestation can result in significant cost-savings in addition to improved health outcomes