Bronchopulmonary Dysplasia In Infants And Its Economic Impact

Bronchopulmonary dysplasia (BPD) is one of the most important sequels of preterm birth and one of the most serious chronic lung diseases in infancy. The etiology of BPD is multifactorial and the prevalence is inversely related to birth weight and gestational age.

The incidence of BPD ranges between 15-50% in very low birth weight infants (VLBWI) (under 1500 g). VLBWI with BPD develop pulmonary hypertension (PH) in 17-45%, which worsen the prognosis and increases the mortality rate.

BPD greatly impacts the quality of life of these babies and increases the economic, psychological and social burden due to very long intensive care hospitalization, need for oxygen therapy at discharge and the repeated hospital admissions due to pulmonary infections. The economic impact of BPD has been estimated mainly in the United States. The cost of a premature infant who develops BPD is 103.151 (SD = 43.842) US$ per day during initial admission, with a mean length of stay of 94.4 days (SD = 31.4). Altogether it has been estimated that each patient with BPD costs $417,000 per year. This cost rises up to $717,000 in patients with PH associated to BPD.

Our BPD research group from the public Health Care System in Spain decided to study the economic impact of preterm birth and BPD. We estimated the cost of premature birth and the associated pulmonary complications in very low birth weight preterm babies, with no other major prematurity-related complications, until two years of age in Spain.

Methods

To estimate this cost we collected data from the different regional councils of Spain. In these regions, the medical cost is quantified by Diagnostic Related Groups (DRGs). DRGs assign different costs to all medical interventions and admissions according to the resources required in each disease, in a way that the cost of the treatment of one DRG should be similar for two different patients. We have estimated the minimum cost of the management and treatment of one index case VLBWI born in Spain, which develops BPD with no other major prematurity-related complications (no surgical procedures) and is discharged alive. This estimation includes the initial hospital care, a two-year standard follow-up, immunization with palivizumab and one hospital admission.

Results

The mean cost of a preterm VLBWI without any other major prematurity-related complications, during the first 2 years of life, ranges between 45,049.81€ and 118,760.43€ in Spain, depending on the birth weight.  If the baby needs home oxygen the cost increases 2,555€ per year, and if the patient develops PH the cost can increase 60,000€ per year. In comparison, a healthy term newborn in Spain costs 909.89€.

Discussion

Neonatal hospitalizations are one of the most expensive admissions in the health system. In the hospitalization of preterm babies it is extremely difficult to extrapolate the respiratory complications from other prematurity-related morbidities, therefore we have estimated the minimum cost, but we should bear in mind that this cost can increase. In addition, patients could require neurological stimulation, costs that are difficult to estimate and are not included in this study.

The indirect and social costs of having a sick child should also be considered. These families have higher rates of divorce and they experience negative consequences in their workplaces.

In conclusion, prematurity and BPD have an elevated cost, even for Public Health Care Systems. This cost will likely increase during the coming years if the incidence and survival of preterm babies keep rising. The development of new preventive strategies to decrease the morbidity associated with prematurity should be a priority. Considering this, the actual research of our BPD study group is aimed towards the development of new preventive strategies with regenerative medicine.

These findings are described in the article entitled The economic impact of prematurity and bronchopulmonary dysplasia, recently published in the European Journal of Pediatrics.

This work was conducted by María Álvarez-Fuente and María Jesús del Cerro from the Hospital Ramón y Cajal, Luis Arruza from the Hospital Clinico San Carlos, Marta Muro and Carmen González-Armengod from the Hospital Puerta de Hierro, Carlos Zozaya and Paloma López-Ortego from the Hospital La Paz, Alejandro Avila from the Complejo Hospitalario de A Coruña, Alba Torrent from the Hospital Vall D’Hebron, and Jose Luis Gavilán from the Hospital Virgen del Rocio.