These include overhead expenditures for housekeeping, administration, and the physical plant. Costs to patients include nonmedical direct costs (such as the cost of transportation to the hospital, meals, and child care for other siblings). Finally, there are costs related to lost productivity, also referred to as indirect costs. In the short run, these are the lost contributions of labor by the parents; in the long run, they also include reduced work alternatives for the patient.
The particular choice of which costs to include is dependent on the perspective of the stakeholder who will be using the information. For example, hospital administrators will be most interested in the direct medical costs that affect hospital financial operations and less interested in wage losses by parents. However, in valuing the financial burden of prematurity to society, it is vitally important to understand the full extent of costs, regardless of the individuals to whom they accrue. In the absence of such information, policy makers may make decisions that appear to be fiscally desirable but in fact simply shift costs to another, unmeasured facet of care.
Studies that measure costs on their own without reference to the effectiveness of an intervention are known as “cost-of-illness studies.” When costs are combined into a single metric with a measure of effectiveness, such as life years saved, the study is referred to as a “cost-effectiveness analysis.” When patient preferences for particular outcomes are used as the measure of effectiveness, as they are in quality-adjusted life years, the study is a known as a “cost-utility analysis.” Both cost-effectiveness and cost-utility analyses express costs and effects as a ratio measure. In contrast, cost-benefit analyses measure effects in monetary terms and subtract this value from the cost of the intervention to determine value for money.
Although much attention has been focused on infants at the borderline of viability, the large volume of children at higher gestational ages may drive the overall financial impact of prematurity. Therefore, broad inclusion criteria were maintained for the review and encompass children in the following categories: (a) premature, defined as birth at less than 37 weeks of gestational age, and (b) low birth weight, defined as a birth weight of less than 2,500 grams.
Although the assessment of efficiency is a critical component of technology assessment, the focus of this appendix is on the absolute financial burden of prematurity and low birth weight rather than on the value for money of treatment modalities. Therefore, only costing studies are included and cost-effectiveness, cost-utility, and cost-benefit studies are excluded,