INTRODUCTION. Preterm birth remains a significant burden to families, health systems and societies. The care of premature babies costs ten to a hundred times more than that of mature infants.

OBJECTIVES. To quantify the health care costs of prematurity and its complications, and to estimate the potential impact of a decrease in the prevalence of prematurity.

METHODS. Over a 6-year time horizon, resource utilization data of inpatient, outpatient and pharmaceutical care for children born after 25 weeks of gestation in 2009/2010 were retrieved from the Hungarian National Health Insurance Fund database. Unit costs in Hungarian Forints were converted to Euro with the average of exchange rates between 2009-2016 (294 HUF/EUR).

RESULTS. 93,124 children (including 8.6% premature babies) were included in the analysis. A strong negative relationship was shown between gestational age and per capita cost. The 6-year cost of care for the cohort born at 26 weeks of gestation (28,470 Euro per capita) was 24.4 times higher than for the cohort born at 40 weeks. First-year inpatient costs accounted for the largest proportion of health care expenditure in the first 6 years after birth in all gestational ages. All investigated prematurity complications (retinopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular cerebral bleeding and leukomalacia) resulted in significant incremental costs. If 50% of pregnancies between 25-36 weeks of gestation were prolonged by 1 week in a year, nearly 5.0 million Euro (10.4% of costs of infants born at 25-36 weeks) could be saved in the first 6 years of life.

CONCLUSIONS. This comprehensive analysis of prematurity-related health care expenditures confirmed that premature infants cost much more than those born at term in Hungary. These quantitative outcomes can provide essential inputs for cost-effectiveness analysis of medical technologies and public health interventions that can decrease the prevalence of prematurity and its ensuing complications.