ECONOMIC OUTCOME FOR INTENSIVE-CARE OF INFANTS OF BIRTH-WEIGHT 500-999 G BORN IN VICTORIA IN THE POST SURFACTANT ERA

Objective: To determine the incremental cost of improving the outcome for extremely low birthweight (ELBW, birthweight 500-999 g) infants bo rn in Victoria after the introduction of exogenous surfactant (the pos t surfactant era), Methodology: This was a geographically determined c ohort study of ELBW children in Victoria, Australia of consecutive liv ebirths born in three distinct eras: (i) 1979-80 (n=351); (ii) 1985-87 (n=560); and (iii) 1991-92 (n=429). Exogenous surfactant was first us ed in Victoria in March, 1991. The consumption of nursery resources pe t livebirth, and the survival and sensorineural disability rates at 2 years of age for each era were investigated. Utilities were assigned a s follows: 0 for dead, 0.4 for severe disability, 0.6 for moderate dis ability, 0.8 for mild disability, and 1 for no disability, Utilities w ere multiplied for more than one disability, Dollar costs were assumed to be $1470 (SA 1992) per day of assisted ventilation, and one dose o f exogenous surfactant was assumed to be equivalent to one third of a day of assisted ventilation. Cost-effectiveness (additional costs per additional survivor or life-year gained) and cost-utility (additional costs per additional quality-adjusted survivor or life-year gained) ra tios were calculated for the pre-surfactant era (1985-87 vs 1979-80), and for the post surfactant era (1991-92 vs 1985-87). Results: Conside ring only the costs incurred during the primary hospitalization. cost- effectiveness and cost-utility ratios were lower (i.e, economically be tter) in the post surfactant era than in the pre-surfactant era (pre-s urfactant vs post surfactant; $7040 vs $4040 per life year gained; $67 00 vs $5360 per quality-adjusted life year gained). Both ratios fell w ith increasing birthweight. In contrast with the pre-surfactant era co st-utility ratios were less favourable than cost-effectiveness ratios in the post surfactant era With costs for long-term care of severely d isabled children added, both cost ratios were higher in the post surfa ctant era. Conclusion: The incremental cost during the primary hospita lization of improving the outcome for ELBW infants has fallen in the p ost surfactant era.