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cost-benefit analysis of the reduction in mortality and morbidity associated with LBW due to advances in neonatal intensive care technology between 1950 and 1990 found that the net societal return was not only high but also outweighed that of several other widely used technologies in health care (Cutler and Meara, 2000). Although the historical advances in neonatal intensive care technology have been vast, as have the increases in the associated costs, the analysis was based on limited available data on the extent of and the quality of life associated with the developmental disabilities associated with LBW. It also ignored the effects of LBW on the quality of life of the family and caregivers and implicitly assumed a zero replacement rate; that is, that no subsequent births were tied to infant deaths associated with LBW. It also converted QALYs to dollars, which, as noted above, runs contrary to the recommendations of a recent expert panel on health valuation (IOM, 2006). Notwithstanding these limitations, the analysis provides a provocative case for the fact that cost-increasing neonatal technologies generate a net societal value. Because the results are tabulated as an average return over a historical period, however, they could not serve as the basis for the incremental evaluation of new technologies or programs for the prevention or treatment of LBW, as the authors noted (Cutler and Meara, 2000).

One recent study of the initial hospitalization cost by week of gestational age for the cohort born in California between 1998 and 2000 demonstrated that substantial reductions in such costs, on average, could be garnered by extending gestation by an additional week, particularly among those infants born at less than 32 weeks of gestation (Phibbs and Schmitt, 2006). The large interquartile variance in cost among those born at each week of gestational age, however, even after accounting for infant mortality, reinforced the high degree of uncertainty over the extent of the savings that would actually be reaped through selective extensions of gestation rather than through general extensions of gestation. In a similar approach applied to LBW, another study found that even small increases in BW could generate significant savings in medical care costs in the first year of life, although such an incremental weight gain among those infants born with a birth weight below a threshold of 750 grams might generate increases in medical costs (Rogowski, 1998). These analyses represent a solid methodological foundation for a more refined economic evaluation of the interventions and programs aimed at the prevention of preterm birth that include longer-term and broader categories of outcomes and associated costs.

CONCLUSIONS

The cost of preterm birth to the nation exceeds $26.2 billion annually and $51,500 per infant born preterm. Although a disproportionate share of



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