RESUMO
BACKGROUND: Low/medium income countries, with health inequalities present high rates of neonates having low birthweight and/or are small for the gestational age. This study aims to analyze the absolute and relative income inequality in the occurrence of low birthweight and small size for gestational age among neonates in four birth cohorts from southern Brazil in 1982, 1993, 2004, and 2011. METHODS: The main exhibit was monthly family income. The outcomes were birth with low birthweight or small for the gestational age. The inequalities were calculated using the Slope Index of Inequality and the Relative Index of Inequality adjusted for maternal skin color, schooling, age, and marital status. RESULTS: In all birth cohorts, poorer mothers were at greater odds of having neonates with low birthweight or small for the gestational age. There was a tendency to decrease the prevalence of small for gestational age in poorer families associated with the reduction of inequalities over the past decades, which was not observed regarding low birthweight. CONCLUSIONS: Economic inequalities occurred in neonates with low birthweight and with intrauterine growth restriction in the four studies, with a higher incidence of inadequate neonatal outcomes in the poorer families.
Assuntos
Retardo do Crescimento Fetal/epidemiologia , Disparidades nos Níveis de Saúde , Renda , Recém-Nascido de Baixo Peso , Recém-Nascido Pequeno para a Idade Gestacional , Pobreza , Nascimento Prematuro/epidemiologia , Adulto , Brasil/epidemiologia , Estudos de Coortes , Feminino , Retardo do Crescimento Fetal/economia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Modelos Logísticos , Gravidez , Nascimento Prematuro/economia , Prevalência , Fatores de RiscoRESUMO
OBJECTIVE: To estimate the direct costs of hospital stay for premature newborns of adolescent mothers, in a public hospital. METHODS: A cost estimate study conducted between 2009 and 2011, in which direct hospital costs were estimated for premature newborns of adolescent mothers, with 22 to 36 6/7 gestational weeks, and treated at the neonatal unit of the hospital. RESULTS: In 2006, there were 5,180 deliveries at this hospital, and 17.8% (922) were newborns of adolescent mothers, of which 19.63% (181) were admitted to the neonatal unit. Out of the 181 neonates, 58% (105) were premature and 80% (84) of them were included in this study. These 84 neonates had a total of 1,633 days in-patient hospital care at a total cost of US$195,609.00. Approximately 72% of this total cost (US$141,323.00) accounted for hospital services. The mean daily costs ranged from US$97.00 to US$157.00. CONCLUSION: This study demonstrated that the average cost of premature newborns from adolescent mothers was US$2,328.00 and varied according to birth weight. For those weighing <1,000g at birth, the mean direct cost was US$8,930.00 per stay as opposed to a cost of US$642.00 for those with birth weight >2,000g. The overall estimated direct cost for the 84 neonates in the study totaled US$195,609.00.
Assuntos
Custos Hospitalares , Recém-Nascido Prematuro , Tempo de Internação/economia , Nascimento Prematuro/economia , Adolescente , Peso ao Nascer , Brasil , Criança , Feminino , Custos de Cuidados de Saúde , Hospitais Públicos , Humanos , Recém-Nascido , Gravidez , Gravidez na Adolescência , Adulto JovemRESUMO
Objective : To estimate the direct costs of hospital stay for premature newborns of adolescent mothers, in a public hospital. Methods : A cost estimate study conducted between 2009 and 2011, in which direct hospital costs were estimated for premature newborns of adolescent mothers, with 22 to 36 6/7 gestational weeks, and treated at the neonatal unit of the hospital. Results : In 2006, there were 5,180 deliveries at this hospital, and 17.8% (922) were newborns of adolescent mothers, of which 19.63% (181) were admitted to the neonatal unit. Out of the 181 neonates, 58% (105) were premature and 80% (84) of them were included in this study. These 84 neonates had a total of 1,633 days in-patient hospital care at a total cost of US$195,609.00. Approximately 72% of this total cost (US$141,323.00) accounted for hospital services. The mean daily costs ranged from US$97.00 to US$157.00. Conclusion : This study demonstrated that the average cost of premature newborns from adolescent mothers was US$2,328.00 and varied according to birth weight. For those weighing <1,000g at birth, the mean direct cost was US$8,930.00 per stay as opposed to a cost of US$642.00 for those with birth weight >2,000g. The overall estimated direct cost for the 84 neonates in the study totaled US$195,609.00. .
Objetivo Estimar os custos diretos de internações de recém-nascidos prematuros de mães adolescentes em um hospital público. Métodos Estudo de estimativa de custos realizado entre 2009 e 2011, no qual os custos hospitalares diretos foram estimados para recém-nascidos prematuros de mães adolescentes, com 22 a 36 6/7 semanas de gestação, e tratados na unidade neonatal do hospital. Resultados Em 2006, o hospital em estudo teve 5.180 partos; 17,8% (922) foram de mães adolescentes, e 19,63% (181) recém-nascidos foram admitidos na unidade neonatal. Dos 181 neonatos, 58% (105) eram prematuros, dos quais 80% (84) foram incluídos neste estudo. Estes 84 recém-nascidos totalizaram 1.633 dias de tratamento hospitalar, a um custo total de US$195,609.00. Aproximadamente 72% desse custo total (US$141,323.00) referiu-se a serviços hospitalares. Os custos médios diários variaram de US$97.00 a US$157.00. Conclusão Este estudo demonstrou que o custo médio de recém-nascido prematuro de mães adolescentes foi US$2,328.00 e variou de acordo com o peso ao nascimento. Para recém-nascidos com peso <1.000g ao nascer, o custo médio foi US$8,930.00, e para os que pesaram >2.000g foi de US$642.00. O custo hospitalar total estimado para os 84 neonatos no estudo foi de US$195,609.00. .
Assuntos
Adolescente , Criança , Feminino , Humanos , Recém-Nascido , Gravidez , Adulto Jovem , Custos Hospitalares , Recém-Nascido Prematuro , Tempo de Internação/economia , Nascimento Prematuro/economia , Peso ao Nascer , Brasil , Custos de Cuidados de Saúde , Hospitais Públicos , Gravidez na AdolescênciaRESUMO
OBJECTIVES: To examine the socioeconomic gradients in birth outcomes among singleton infants in Argentina, 2003-2007. METHODS: We analyzed data of 3,230,031 singleton infants born in 2003-2007, obtained from vital statistics. Associations between birth outcomes [small for gestational age (SGA), low birth weight (LBW), and preterm birth (PTB)] and socioeconomic indicators (maternal education and area-based material deprivation quintiles) were assessed with logistic regression. RESULTS: The risk of SGA increased with higher socioeconomic disadvantage, but that of PTB decreased. Compared to mothers who attained a tertiary or university degree, mothers who did not complete primary school were more likely to have a SGA infant [adjusted OR (95 % CI): 1.65 (1.62, 1.68)], but less likely to deliver preterm [0.92 (0.90, 0.94)]. As a result of the conflicting trends in SGA and PTB, LBW exhibited inconsistent socioeconomic gradients. CONCLUSIONS: The excess risk of adverse birth outcomes associated with socioeconomic disadvantage was consistently reflected by SGA, but not by LBW and PTB. These findings challenge the usefulness of LBW as an indicator population health. Further research is needed to explain the reverse socioeconomic gradients in PTB.
Assuntos
Recém-Nascido Pequeno para a Idade Gestacional , Mães/estatística & dados numéricos , Resultado da Gravidez/economia , Nascimento Prematuro/economia , Adolescente , Adulto , Argentina , Escolaridade , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Parto , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: To investigate whether the February 27th earthquake exposition was associated to adverse perinatal outcomes in Chilean pregnant women. METHODS: We analyzed all deliveries occurred in 2009 (n = 3,609) and 2010 (n = 3,279) in a reference hospital in the area of the earthquake. Furthermore, we investigated pregnant women who gave birth between March 1st and December 31st 2010 (n = 2,553) and we classified them according to timing of exposition. RESULTS: We found a 9% reduction in birth rate, but an increase in the rate of early preterm deliveries (<34 weeks), premature rupture of membranes (PROM), macrosomia, small for gestational age, and intrauterine growth restriction (IUGR) after the earthquake, in contrast to the previous year. Women exposed to the earthquake during her first trimester delivered smaller newborns (3,340 ± 712 g v/s 3,426 ± 576 g respectively, p = 0.007) and were more likely diagnosed with early preterm delivery, preterm delivery (<37 weeks) and PROM but were less likely diagnosed with IUGR and late delivery (42 weeks, p < 0.05) compared to those exposed at third trimester. Accordingly, IUGR and preterm deliveries presented elevated healthcare costs. CONCLUSION: Natural disasters such as earthquakes are associated to adverse perinatal outcomes that impact negatively the entire maternal-neonatal healthcare system.
Assuntos
Desastres , Terremotos , Complicações na Gravidez/etiologia , Trimestres da Gravidez , Adulto , Coeficiente de Natalidade , Chile/epidemiologia , Feminino , Retardo do Crescimento Fetal/economia , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Ruptura Prematura de Membranas Fetais/economia , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/etiologia , Custos de Cuidados de Saúde , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Razão de Chances , Gravidez , Complicações na Gravidez/economia , Complicações na Gravidez/epidemiologia , Gravidez Prolongada/economia , Gravidez Prolongada/epidemiologia , Gravidez Prolongada/etiologia , Nascimento Prematuro/economia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Fatores de RiscoRESUMO
OBJECTIVES: To estimate the direct costs of hospital stays for premature newborns in the Interlagos Hospital and Maternity Center in São Paulo, Brazil and to assess the difference between the amount reimbursed to the hospital by the Unified Health System and the real cost of care for each premature newborn. METHODS: A cost-estimate study in which hospital and professional costs were estimated for premature infants born at 22 to 36 weeks gestation during the calendar year of 2004 and surviving beyond one hour of age. Direct costs included hospital services, professional care, diagnoses and therapy, orthotics, prosthetics, special materials, and blood products. Costs were estimated using tables published by the Unified Health System and the Brasindice as well as the list of medical procedures provided by the Brazilian Classification of Medical Procedures. RESULTS: The average direct cost of care for initial hospitalization of a premature newborn in 2004 was $2,386 USD. Total hospital expenses and professional services for all premature infants in this hospital were $227,000 and $69,500 USD, respectively. The costs for diagnostic testing and blood products for all premature infants totaled $22,440 and $1,833 USD. The daily average cost of a premature newborn weighing less than 1,000 g was $115 USD, and the daily average cost of a premature newborn weighing more than 2,500 g was $89 USD. Amounts reimbursed to the hospital by the Unified Health System corresponded to only 27.42% of the real cost of care. CONCLUSIONS: The cost of hospital stays for premature newborns was much greater than the amount reimbursed to the hospital by the Unified Health System. The highest costs corresponded to newborns with lower birth weight. Hospital costs progressively and discretely decreased as the newborns' weight increased.
Assuntos
Tempo de Internação/economia , Nascimento Prematuro/economia , Peso ao Nascer , Brasil , Custos de Cuidados de Saúde , Custos Hospitalares , Hospitais Públicos/economia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Fatores de TempoRESUMO
OBJECTIVES: To estimate the direct costs of hospital stays for premature newborns in the Interlagos Hospital and Maternity Center in São Paulo, Brazil and to assess the difference between the amount reimbursed to the hospital by the Unified Health System and the real cost of care for each premature newborn. METHODS: A cost-estimate study in which hospital and professional costs were estimated for premature infants born at 22 to 36 weeks gestation during the calendar year of 2004 and surviving beyond one hour of age. Direct costs included hospital services, professional care, diagnoses and therapy, orthotics, prosthetics, special materials, and blood products. Costs were estimated using tables published by the Unified Health System and the Brasindice as well as the list of medical procedures provided by the Brazilian Classification of Medical Procedures. RESULTS: The average direct cost of care for initial hospitalization of a premature newborn in 2004 was $2,386 USD. Total hospital expenses and professional services for all premature infants in this hospital were $227,000 and $69,500 USD, respectively. The costs for diagnostic testing and blood products for all premature infants totaled $22,440 and $1,833 USD. The daily average cost of a premature newborn weighing less than 1,000 g was $115 USD, and the daily average cost of a premature newborn weighing more than 2,500 g was $89 USD. Amounts reimbursed to the hospital by the Unified Health System corresponded to only 27.42 percent of the real cost of care. CONCLUSIONS: The cost of hospital stays for premature newborns was much greater than the amount reimbursed to the hospital by the Unified Health System. The highest costs corresponded to newborns with lower birth weight. Hospital costs progressively and discretely decreased as the newborns' weight increased.
Assuntos
Humanos , Recém-Nascido , Tempo de Internação/economia , Nascimento Prematuro/economia , Peso ao Nascer , Brasil , Custos de Cuidados de Saúde , Custos Hospitalares , Hospitais Públicos/economia , Recém-Nascido Prematuro , Fatores de TempoRESUMO
BACKGROUND: Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico. METHODS AND FINDINGS: A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24-26, 27-29, and 30-33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24-26, 27-29, and 30-33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses. CONCLUSIONS: Incremental cost-effectiveness ratios for neonatal intensive care imply very high value for money on the basis of conventional benchmarks for cost-effectiveness analysis. Please see later in the article for the Editors' Summary.
Assuntos
Análise Custo-Benefício , Terapia Intensiva Neonatal/economia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , México , Gravidez , Nascimento Prematuro/economiaRESUMO
Objetivos: Calcular los costos de la atención neonatal de recién nacidos prematuros y en portadores de malformaciones congénitas mayores compatibles con la vida. Pacientes y Método: Estudio retrospectivo efectuado en el Departamento de Ginecología y Obstetricia del Hospital Clínico de la Universidad de Chile, en 82 recién nacidos menores de 34 semanas de gestación y en 14 con malformaciones congénitas mayores, de más de 37 semanas de gestación, compatibles con la vida, atendidos entre enero y diciembre de 2004. Resultados evaluados son los costos de la atención neonatal subdivididos en componentes. Resultados: El costo promedio de la atención neonatal en recién nacidos menores de 34 semanas fue igual a $2.519.508, en menores de 32 semanas igual a $3.766.999, en menores de 1500 gramos igual a $12.017.650 y en portadores de malformaciones congénitas mayores compatibles con la vida de $30.967.180. El día cama representa el componente más significativo dentro cada paquete con más del 60 por ciento del costo promedio. Conclusiones: El costo de la atención neonatal de prematuros menores de 34 semanas o portadores de malformaciones congénitas mayores compatibles con la vida es mayor al contemplado en los paquetes de prestaciones a todo evento, representando el día cama su componente más significativo.
Objective: To calculate the cost involved in the neonatal care of premature or live born babies carriers of mayor congenital abnormalities compatible with life. Patients and method: Retrospective study who analyzed 82 premature live born of less than 34 weeks and 14 live born carriers of mayor congenital abnormalities compatible with life, from January to December 2004, at the Maternity Ward from the University of Chile Clinical Hospital. The outcome measures were the neonatal care average cost package subdivided by components. The cost was expressed in chilean currency. Results: Neonatal care average cost was $2.519.508 in live born of less than 34 weeks, $3.766.999 in less than 32 weeks, $12.017.650 in less than 1500 grams babies and $30.967.180 in carriers of mayor congenital abnormalities. In bed day cost represents the most significant component from the package, representing more than 60 percent of its total cost. Conclusions: Neonatal care cost of premature live born of less than 34 weeks or carriers of mayor congenital abnormalities compatible with life is higher than the maximum cost considered in the every-event health packages, representing in bed day its most significant component.