COSTS OF CARE FOR VLBW INFANTS

描述（由申请人提供）：极低出生体重（出生时低于1500克）的婴儿是弱势患者群体。美国的高婴儿死亡率集中在这些婴儿身上。虽然他们只占出生人数的1%，但极低体重婴儿占婴儿死亡人数的46%。出生体重过低的婴儿也是高成本的患者群体。新生儿重症监护室对出生体重非常低的婴儿的护理是最昂贵的住院治疗之一。例如，1987年出生体重在500至749克之间的存活婴儿初次住院的平均费用为157 000美元。然而，有关这些婴儿护理费用的最新数据是10年前的。大多数文献都是基于20年前的数据。在这段时间里发生了许多变化，预计会改变这些婴儿护理的成本和成本效益。这包括保健市场的变化，例如出现了管理式护理计划和护理地点的变化，以及新生儿和产科护理方面的技术变化。自1980年以来，后者在很大程度上使婴儿死亡率降低了40%。关于护理成本和成本效益的信息对决策者很重要。例如，俄勒冈州医疗补助计划最初提议将出生体重在500克以下的婴儿的护理放在成本效益评级的底部，从而实质上拒绝为这些婴儿提供护理。最终，护理没有因为基于《美国残疾人法案》的法律挑战而被拒绝。关于超低体重婴儿护理费用的信息对于确定旨在降低早产率的干预措施的成本效益尤为重要。后者在美国是一个高度优先的政策。美国是工业化国家中婴儿死亡率最高的国家之一，主要原因是早产率高。先前的文献表明，这些干预措施的成本效益取决于出生体重分布的变化，特别是在最低出生体重时。在本研究中，我们建议通过使用1997-2000年的最新数据来填补这一知识空白，以回答以下问题：(1)照顾超低体重婴儿的成本是什么？(2)超低体重婴儿护理的成本效益如何？(3)护理的成本和成本效益如何随早产程度而变化？这项研究将使用在研究期间来自佛蒙特牛津网络29家医院的数据。它包括13610名出生体重在1500克以下的婴儿，这是成本研究中最大的VLBW婴儿样本。佛蒙特牛津网络是新生儿重症监护病房的自愿合作网络，旨在提高新生儿医疗保健的有效性和效率。

DESCRIPTION (provided by applicant): Infants with very low birth weights (under 1500 grams at birth) are a vulnerable patient population. The high rates of infant mortality in the United States are concentrated among these babies. While they account for only 1 percent of births, VLBW infants account for 46 percent of infant deaths. Infants with very low birth weights are also a high cost patient population. NICU care for infants with very low birth weights are among the most expensive hospitalizations. For instance, the average cost of the initial hospitalization for a surviving infant with a birth weight between 500 and 749 grams in 1987 was $157,000. Yet, the most recent data for the costs of care for these infants are a decade old. Most of the literature is based on data that is two decades old. There have been many changes in that time period that would be expected to change the cost and cost-effectiveness of care for these infants. This includes changes in the health care marketplace, such as the emergence of managed care plans and shifts in the sites of care, and technological changes in both neonatal and obstetric care. The latter have been largely responsible for a 40 percent reduction in infant mortality rates since 1980. Information on cost and cost-effectiveness of care is important for policy makers. For instance, the Oregon Medicaid program initially proposed placing care for infants with birth weights under 500 grams at the bottom of their cost-effectiveness rating, thus essentially denying care for these infants. Ultimately, care was not denied due to legal challenges based on the Americans with Disabilities Act. Information on costs of care for VLBW infants is particularly important for determining the cost-effectiveness of interventions aimed at decreasing the rate of preterm birth. The latter is a high policy priority in the United States. The US has one of the highest infant morality rates among industrialized nations, due largely to high rates of premature births. The prior literature has demonstrated that the cost-effectiveness of these interventions depends on how the birth weight distribution is shifted, particularly at the lowest birth weights. In this study we propose to fill this knowledge gap by using more recent data, from 1997-2000 to answer the following questions: (1) What are the costs of care for VLBW infants? (2) What is the cost-effectiveness of care for VLBW infants? (3) How do costs and cost-effectiveness of care vary with the degree of prematurity? The study will use data from 29 hospitals in the Vermont Oxford Network over the study period. It includes 13,610 infants with birth weights under 1500 grams, the largest sample of VLBW infants ever included in a cost study. The Vermont Oxford Network is a voluntary, collaborative network of neonatal intensive care units organized to improve the effectiveness and efficiency of medical care for newborn infants.