期刊
ANNALS OF MEDICINE
卷 43, 期 -, 页码 S47-S53出版社
TAYLOR & FRANCIS LTD
DOI: 10.3109/07853890.2011.586359
关键词
Centralisation; mortality; morbidity; outcome and process assessment (health care); registries; specialisation; very low birth weight infants; very low gestational age; follow-up studies
资金
- Abbott
- Nycomed
- Ferring
- Finnish Academy
- Finnish Innovation Fund SITRA
- Helsinki University Central Hospital EVO
- Turku University Hospital EVO
Introduction. This article summarizes the main findings of the preterm infant sub-study of the Performance, Effectiveness and Costs of Treatment episodes (PERFECT) study. We studied effects of birth hospital level and time of birth on mortality and morbidity and cost-effectiveness of care of very low gestational age (VLGA)/very low birth weight (VLBW) infants. Material and Methods. The study included all infants born below 32 weeks or 1501 g in Finland in 2000--2007. Different cohorts were used depending on the time point. Results. The one-year mortality of live-born VLBW/VLGA infants was higher if born in level II versus level III hospitals, or if born during out-of-office hours in level II versus office hours in level III hospitals. Two out of three VLGA/VLBW subjects did not have any of the prematurity-related morbidities studied. The average cost of quality-adjusted life years was euroa,not sign19,245 by four years of age; the cost was higher in VLGA/VLBW infants with long-term morbidities. Discussion. Birth in a level III hospital improved survival of VLGA/VLBW infants. Results suggest inadequate overnight competence in small hospitals. Despite high initial costs, care of VLGA/VLBW infants was already cost-effective by four years of age. Cost-effectiveness can be improved by reducing long-term morbidities.
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