Postpartum Length of Stay and Newborn Health: A Cost-Effectiveness Analysis

Abstract

ABSTRACT. Objective. To evaluate the cost-effectiveness of increasing lengths of brief postpartum hospitalizations.Methods. A cost-effectiveness model extrapolating from secondary data was used. Social costs in 2000 US dollars were estimated using several sources, including a randomized controlled trial, a retrospective study, and survey data. Life-years saved from reduced infant mortality were estimated from administrative data from Washington State. A total of 113 147 singleton newborns who were born in nonmilitary hospitals in Washington State in 1989 or 1990 and had postpartum stays short enough to be affected by length of stay legislation were studied. The cost-effectiveness of increases in postpartum lengths of stay similar to those that would occur if all mothers and singleton newborns used at least the time allotted to them under the federal length of stay legislation was measured.Results. Estimated lower-bound cost per newborn life-year saved was $19 800 (95% confidence interval: $11 600 -$61 300) when only neonatal deaths were considered. The corresponding upper-bound estimate was $94 800 (95% confidence interval: $55 200 -$286 800). The results were very sensitive to assumptions about the discount rate for future life-years and the time from birth during which averted deaths are considered (neonatal deaths, postneonatal infant deaths, or all infant deaths).Conclusions. At hospitals that do not experience additional capacity costs as a result of increased lengths of stay, lengthening short postpartum stays seems to be more cost-effective than many common health interventions and well below cost-effectiveness thresholds suggested by the literature. Even at hospitals that experience additional capacity costs, the cost-effectiveness of lengthening short postpartum stays seems to be roughly equal to the benchmark of $100 000 per quality-adjusted life-year suggested by the literature. Pediatrics 2003;111:e316 -e322. URL: http://www.pediatrics.org/cgi/content/full/111/4/e316; postpartum, length of stay, newborn, mortality, cost.

The Association between Intended Mode of Delivery and Maternal Morbidity in Twin Pregnancies

“…This has important financial implications, as the cost of an elective CD coupled with the cost of a longer hospital stay places added burden on the health care system. 16 Although we did not find significantly different rates of postpartum endometritis or wound infection between the groups, a longer hospitalization also does increase the risk of hospital-acquired infections. 10 Finally, it is important to consider the differences in CD rates between women who intended to labor and those who had an elective CD.…”

A Robustified Modeling Approach to Analyze Pediatric Length of Stay

“…Pediatric hospitalizations characteristically comprise a major budgetary item for governments, international health agencies and other health care providers. Therefore, comprehensive and accurate information about inpatient length of stay (LOS) should be a high priority for health planners and administrators in the strategic planning and deployment of financial, human and physical resources for these and related agencies [2][3][4][5]. In addition to resource allocation and quality control, there is also patient interest in anticipated dates of discharge [6].…”

Satisfying parents’ preferences with regard to various models of postnatal care is cost‐minimizing

“…There is always a risk that care lacking in resources goes outside of what is medically defensible. The LOS may have an influence on infant mortality, but opinions differ about whether lengthening short postpartum stays is cost‐effective or not 10 and whether early discharge is a safe and cost‐effective care option 9, 19, 20. It is important to determine what is safe for the mother and newborn with regard to postnatal care, irrespective of the care option.…”

“…This type of care has not been evaluated in detail, but an American study argues that the family suite prevents mothers and their infants from being prematurely discharged from a health facility 3. Furthermore, if a short LOS increases infant mortality, lengthening short postpartum stays would be more cost‐effective than many common health interventions, such as pneumococcal conjugate vaccine programs for infants, calculated in US$ per life‐year saved 10.…”