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Clinical benefits,costs,and cost-effectiveness of neonatal intensive care in Mexico
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نویسنده
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profit j. ,lee d. ,zupancic j.a. ,papile l. ,gutierrez c. ,goldie s.j. ,gonzalez-pier e. ,salomon j.a.
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منبع
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plos medicine - 2010 - دوره : 7 - شماره : 12
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چکیده
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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. © 2010 profit et al.
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آدرس
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baylor college of medicine,department of pediatrics,texas children's hospital,section of neonatology,houston,tx,united states,baylor college of medicine,department of medicine,section of health services research,houston,tx, United States, harvard university,harvard initiative for global health,cambridge,tx, United States, beth israel deaconess medical center,department of neonatology,boston,ma,united states,harvard medical school,department of pediatrics,division of newborn medicine,boston,ma, United States, baylor college of medicine,department of pediatrics,texas children's hospital,section of neonatology,houston,tx, United States, mexican ministry of health,economic analysis unit,méxico d.f, Mexico, harvard university,harvard initiative for global health,cambridge,tx,united states,harvard school of public health,department of health policy and management,boston,ma,united states,harvard school of public health,center for health decision science,boston,ma, United States, fundacio ́n mexicana para la salud,méxico d.f, Mexico, harvard university,harvard initiative for global health,cambridge,tx,united states,harvard school of public health,center for health decision science,boston,ma,united states,harvard school of public health,department of global health and population,boston,ma, United States
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Authors
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