Preterm birth in singleton and multiple pregnancies: evaluation of costs and perinatal outcomes Gert J. van Baaren a,1, *, Myrthe J.C.S. Peelen a,1, *, Ewoud Schuit a,b , Joris A.M. van der Post a , Ben W.J. Mol c , Marjolein Kok a , Petra J. Hajenius a a Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands b Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands c The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Australia Introduction Preterm birth is the most important issue in obstetric care in the developed world. Of all perinatal mortality, 50–70% occurs after preterm birth and it is a major cause of neonatal morbidity [1,2]. Many developed countries have reported increasing preterm birth rates for the last two decades [3]. Results from the Global Burden of Disease (GBD) Study 2010 show that preterm birth complications attributed for 3.1% to all DALYs (disability-adjusted life years). As a result, preterm birth was 8th on the GBD ranking in 2010, despite the improvement in neonatal treatment of preterm infants in the last decades [4]. Interventions that may delay preterm birth, like administration of progestagens or use of a cervical pessary, are currently focus of research [5–9]. Preterm birth is important because of its adverse perinatal outcomes and of its associated health care costs. The annual financial burden of preterm birth in the USA was estimated to be $26 billion in 2005 [10]. Phibbs et al. reported population-based data that can be applied to clinical trials to assess the impact on costs of potential interventions that delay preterm birth [11]. They calculated (hospital) costs based on length of stay until discharge or neonatal death only, and found that potential savings were quite large; costs decreased from a median of $216,814 for infants born at 24 weeks to $591 for infants born at 37 weeks. They did not European Journal of Obstetrics & Gynecology and Reproductive Biology 186 (2015) 34–41 A R T I C L E I N F O Article history: Received 22 August 2014 Received in revised form 16 December 2014 Accepted 23 December 2014 Keywords: Premature birth Costs Perinatal mortality Perinatal morbidity Multiple pregnancy A B S T R A C T Objective: To estimate costs of preterm birth in singleton and multiple pregnancies. Study design: Cost analysis based on data from a prospective cohort study and three multicentre randomised controlled trials (2006–2012) in a Dutch nationwide consortium for women’s health research. Women with preterm birth before 37 completed weeks were included for analysis. Direct costs were estimated from a health care perspective, from delivery until discharge or decease of the neonates. Costs and adverse perinatal outcome per pregnancy were measured. Adverse perinatal outcome comprised both perinatal mortality and a composite of neonatal morbidity defined as chronic lung disease, intraventricular haemorrhage  grade 2, periventricular leukomalacia  grade 1, proven sepsis or necrotising enterocolitis. Using a moving average technique covering three weeks per measurement, costs and adverse perinatal outcome per woman delivering for every week between 24 and 37 weeks are reported. Results: Data of 2802 women were available of whom 1503 (53.6%) had a preterm birth; 501 in 1090 singleton (46%) and 1002 in 1712 multiple pregnancies (58.5%). The most frequent perinatal outcomes were perinatal mortality, chronic lung disease and sepsis. For singleton pregnancies the peak of total costs was at 25 weeks (s88,052 per delivery), compared to 27 weeks for multiple pregnancies (s169,571 per delivery). The total costs declined rapidly with increasing duration of pregnancy. Major cost drivers were length of stay on the NICU and airway treatments. The peaks seen in costs paralleled with the prevalence of adverse perinatal outcome. Conclusions: These data can be used to elaborate on the impact of preterm birth in case only data are available on duration of pregnancy. ß 2014 Elsevier Ireland Ltd. All rights reserved. * Corresponding authors at: Department of Obstetrics and Gynaecology, Academic Medical Centre, Room H4-232, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel.: +31 648774355; fax: +31 206963489. E-mail addresses: g.j.vanbaaren@amc.nl (G.J. van Baaren), m.j.peelen@amc.nl (Myrthe J.C.S. Peelen). 1 Both authors contributed equally to this work. Contents lists available at ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology jou r nal h o mep ag e: w ww .elsevier .co m /loc ate/ejo g rb http://dx.doi.org/10.1016/j.ejogrb.2014.12.024 0301-2115/ß 2014 Elsevier Ireland Ltd. All rights reserved.