Conclusions
I have not done justice to the considerable amount of research that has been reported on the costs and economics of neonatal care. However, I can draw a few conclusions from this review. In spite of difference in methods, there is consistency between studies in the picture of the cost of providing neonatal care, and the relationship between costs for different groups of babies. I have reported the costs for very low birthweight babies requiring intensive care. Several authors have commented that more than half the workload in a neonatal unit is taken up by care of bigger babies and recovering survivors of neonatal intensive care. There is very little evidence about the costs of care of these babies, especially those that do not require intensive care or surgery. There is, however, increasing interest in the question of appropriate admission and discharge policies for NICUs. I have shown that the economics of NICU care may have been changed by the introduction of surfactant and by the wider use of antenatal corticosteroids.
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Appendix B
1. Included in review
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2. Excluded from review
Bell RE, Ackerman NB, Yoder BA, Null DM, de Lemos RA. Military neonatal transport and intensive care-effective and cost effective. Milit Med 1984;149:143–145.
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1. Included in review
Backhouse ME, Mauskopf JA, Jones D, Wold DE, Schumacher R, Long WE. Economic outcomes of calfosceril palmitate rescue therapy in infants weighing 1250 g or more with respiratory dishes syndrome: Results from a randomized trial. Pharmacoeconomics 1994;6:358–369.
Egberts J. Department of Obstetrics and Gynaecology. Theoretical changes of the costs of hospitalization of neonates after the introduction of the surfactant Curosurf. Forthcoming September 1994.
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Mauskopf JA, Backhouse ME, Jones D, Wold DE, Mammel MC, Mullet M, et al. A cost-effectiveness analysis of synthetic surfactant for rescue treatment of respiratory distress syndrome in premature infants weighing from 700 g to 1350 g. (pers. comm).
Mugford M, Piercy J, Chalmers I. Cost implications of different approaches to the prevention of respiratory distress syndrome. Arch Disease in Childhood 1991;66:757–764.
Phibbs CS, Phibbs RH, Wakeley Ann, Schlueter MA, Sniderman S, Tooley WH. Cost-effects of surfactant therapy for neonatal respiratory distress syndrome. J Pediatr 1993;123:953–962.
Shennan A, Dunn M, Possmayer F. Cost-effectiveness of single dose surfactant prophylaxis in infants of less than 30 weeks gestation. Pediatr Res 1989;25:231 a.
Simpson K, Lynch SR. Cost savings from the use of antenatal steroids to prevent respiratory distress syndrome and related conditions in premature infants. Am J Obstetrics Gynecol Forthcoming (1994).
Tubman TRJ, Halliday HL, Normand C. Cost of surfactant replacement treatment for severe neonatal respiratory distress syndrome: a randomised controlled trial. Br Med J 1990;301:842–845.
Virtanen M, Kuhlefelt S, Makela-Bengs P, Jarvenpaa A. p 90. Proceedings of the Annual Meeting of the European Society for Paediatric Research.
2. Exluded from review
Backhouse ME. Cost-effectiveness of Exosurf neonatal rescue therapy in infants with RDS. Adv in Paediatr 1992; Jan:8.
Hope P. Exogenous surfactants-They work and are expensive. Br Med J 1991;303:799–800.
Hyde CJ. Advising on the introduction of the drug exosurf in Norwich Health Authority [Dissertation], 1994.
Merritt TA, Hallman M, Vaucher Y, McFeeley E, Tubman TRJ. Impact of surfactant treatment on cost of neonatal intensive care: a costbenefit analysis. J Perinatol 1990;10:416–419.
Phibbs CS, Phibbs RH, Tooley WH, Wakely A, Sniderman S. The cost effectiveness of synthetic surfactant therapy for neonatal respiratory distress syndrome. Clin Res 1990;38:178 a.
Robertson B. The dilemmas of surfactant replacement. J Perin Med 1991;19:183–188.
Sittlington N, Tubman R, Halliday HL. Surfactant replacement therapy for severe neonatal respiratory distress syndrome: implications for nursing care. Midwifery 1991;7:20–24.
Tubman TRJ, Halliday HL, Normand C. Economic impact of porcine surfactant replacement (Curosurf) for severe neonatal respiratory distress syndrome. J Perin Med 1991;19:403–407.
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Mugford, M. The cost of neonatal care: Reviewing the evidence. Soz Präventivmed 40, 361–368 (1995). https://doi.org/10.1007/BF01325418
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DOI: https://doi.org/10.1007/BF01325418