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PEDIATRICS Vol. 114 No. 2 August 2004, pp. 508

The Cost-Benefit Threshold for Low Birth Weight Infants

Albert L. Mehl, MD, FAAP
Colorado Permanente Medical Group
Boulder, CO 80304

To the Editor.—

The article by Doyle et al¹ calls attention to several important cost measures as they relate to the provision of neonatal intensive care, including the "cost-effectiveness" and "cost-utility" ratios. In addition to these important measures of value in providing medical care to this unique population, the reader is encouraged to contrast these standards with the "cost-benefit threshold" (CBT) first introduced in 1992.²

The CBT represents a specific day in the life of hospitalized premature infants as measured against the standardized value of a universally recognized tangible asset; it is the day that the premature infant is worth his weight in gold.

The CBT can be calculated as follows. From the work of Shaffer et al, ³ an approximate prediction of weight on any given day of life can be calculated. Assuming that the nadir of weight loss occurs at 5 days of age, the weight on day 5 (WtDay5) can be approximated as:

(1)

where BW is the birth weight in kilograms. After 5 days of age, the subsequent weight on the day of CBT (WtDayCBT) can be estimated by adding 15 g/kg per day of linear growth after day 5:

(2)

The total accumulating cost of care in the neonatal intensive care unit can be estimated by using an average cost per day (CPD). As an example, the estimated CPD in tertiary neonatal intensive care centers in Colorado has been estimated to be $3000.

Eventually, on the day of CBT, the total accumulating cost of medical care (CPD x DayCBT) will be equal to the product:

(3)

where POG is the price of gold in US dollars per troy ounce. Then, by substituting for WtDayCBT, one can solve for the day of CBT:

(4)

As an example, using a birth weight of 1.0 kg, a CPD of $3000, and a price of gold of $400 per oz, one would calculate that the CBT would occur; that is to say, the infant would be worth his weight in gold on day 4!

REFERENCES

1. Doyle LW, Victorian Infant Collaborative Study Group. Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: II. Efficiency. Pediatrics.2004; 113 :510 –514[Abstract/Free Full Text]
2. Mehl A. The cost-benefit threshold [letter]. Clin Pediatr (Phila).1992; 31 :190 –191[Free Full Text]
3. Shaffer SG, Quimiro CL, Anderson JV, Hall RT. Postnatal weight changes in low birth weight infants. Pediatrics.1987; 79 :702 –705[Abstract/Free Full Text]

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Lex W. Doyle, MD, FRACP
Department of Obstetrics and Gynaecology
Royal Women’s Hospital
Victoria 3053, Australia

In Reply.—

A full economic evaluation of any health care program requires a comparison of both the costs and consequences of competing health care programs. In the case of our study,¹ the competing health care programs were between successive eras, as was the case in the seminal study by Boyle et al² on the evaluation of neonatal intensive care. Boyle et al reported not only cost-effectiveness and cost-utility ratios, as in our study, but they also reported cost-benefit analysis, which investigates the net economic benefit (or loss) in dollars by subtracting the incremental costs of the competing programs from the incremental earnings of the competing programs. Thus, a true cost-benefit analysis should not be confused with the description of "cost-benefit threshold" by Mehl, in which is not a full economic evaluation and there is no attempt to compare competing health care programs to obtain incremental costs and earnings.

REFERENCES

1. Doyle LW, Victorian Infant Collaborative Study Group. Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: II. Efficiency. Pediatrics.2004; 113 :510 –514
2. Boyle MH, Torrance GW, Sinclair JC, Horwood SP. Economic evaluation of neonatal intensive care of very-low-birth-weight infants. N Engl J Med.1983; 308 :1330 –7[Abstract]

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PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

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