Cost of clinician-driven tests and treatments in very low birth weight and/or very preterm infants

Brian C King; Troy Richardson; Ravi M Patel; Henry C Lee; Nicolas A Bamat; Stephen W Patrick; Kanekal S Gautham; Matthew Hall; Jonathan L Slaughter

doi:10.1038/s41372-020-00879-6

Cost of clinician-driven tests and treatments in very low birth weight and/or very preterm infants

J Perinatol. 2021 Feb;41(2):295-304. doi: 10.1038/s41372-020-00879-6. Epub 2020 Dec 2.

Authors

Brian C King¹, Troy Richardson², Ravi M Patel³, Henry C Lee⁴, Nicolas A Bamat⁵, Stephen W Patrick⁶, Kanekal S Gautham⁷, Matthew Hall², Jonathan L Slaughter⁸

Affiliations

¹ Section of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA. bcking@bcm.edu.
² Children's Hospital Association, Lenexa, KS, USA.
³ Division of Neonatology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
⁴ Division of Neonatology, Stanford University, Stanford, CA, USA.
⁵ Divison of Neonatology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
⁶ Vanderbilt Center for Child Health Policy, Departments of Pediatrics and Health Policy, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA.
⁷ Section of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
⁸ Divison of Neonatology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.

PMID: 33268831
DOI: 10.1038/s41372-020-00879-6

Abstract

Objective: To rank clinician-driven tests and treatments (CTTs) by their total cost during the birth hospitalization for preterm infants.

Study design: Retrospective cohort of very low birth weight (<1500 g) and/or very preterm (<32 weeks) subjects admitted to US children's hospital Neonatal Intensive Care Units (2012-2018). CTTs were defined as pharmaceutical, laboratory and imaging services and ranked by total cost.

Results: 24,099 infants from 51 hospitals were included. Parenteral nutrition ($85M, 32% of pharmacy costs), blood gas analysis ($34M, 29% of laboratory costs), and chest radiographs ($18M, 31% of imaging costs) were the costliest CTTs overall. More than half of CTT-related costs occurred during 10% of hospital days.

Conclusions: The majority of CTT-related costs were from commonly used tests and treatments. Targeted efforts to improve value in neonatal care may benefit most from focusing on reducing unnecessary utilization of common tests and treatments, rather than infrequently used ones.

MeSH terms

Birth Weight
Child
Humans
Infant
Infant, Newborn
Infant, Premature*
Infant, Premature, Diseases*
Infant, Very Low Birth Weight
Intensive Care Units, Neonatal
Retrospective Studies