The Economics of Treatment for Infants with Respiratory Distress Syndrome

Objectives. To define clinical outcomes and prevailing patterns of care for the initial hospitalization of infants at greatest risk for respiratory distress syndrome (RDS); to estimate direct medical care costs associated with the initial hospitalization; and to introduce and demonstrate a simulation technique for the economic evaluation of health care technologies. Method. Clinical outcomes and usual-care algorithms were determined for infants with RDS in three birthweight categories (500-1,000 g; >1,000- 1,500 g; and >1,500 g) using literature- and expert-panel-based data. The experts were practitioners from major U.S. hospitals who were directly involved in the clinical care of such infants. Using the framework derived from the usual care patterns and outcomes, the authors developed an itemized "micro-costing" economic model to sim ulate the costs associated with the initial hospitalization of a hypothetical RDS patient. The model is computerized and dynamic; unit costs, frequencies, number of days, probabilities and population multipliers are all variable and can be modified on the basis of new information or local conditions. Aggregated unit costs are used to estimate the expected medical costs of treatment per patient. Results. Expected costs of initial hospitalization per uncomplicated surviving infant with RDS were estimated to be $101,867 for 500-1,000 g infants; $64,524 for >1,000-1,500 g infants; and $27,224 for >1,500 g infants. Incremental costs of complications among survivors were esti mated to be $22,155 (500-1,000 g); $11,041 (>1,000-1,500 g); and $2,448 (>1,500 g). Expected costs of initial hospitalization per case (including non-survivors) were $100,603; $72,353; and $28,756, respectively. Conclusions. An itemized model such as the one developed here serves as a benchmark for the economic assessment of treatment costs and utilization. Moreover, it offers a powerful tool for the prospective evaluation of new technologies or procedures designed to reduce the incidence of, severity of, and/or total hospital resource use ascribed to RDS. Key words: respiratory distress syndrome; low birthweight; technology assessment; economics; costs. (Med Decis Making 1998;18:44-51)