The cost of prematurity: a case-control study of twins vs singletons

• Published in: American journal of public health (1971) 1996-06, Vol.86 (6), p.809-814
• Main Authors: Luke, B, Bigger, H R, Leurgans, S, Sietsema, D
• Format: Article
• Language: English
• Subjects: Babies; Biological and medical sciences; Birth Weight; Case controlled studies; Case-Control Studies; Chicago; Childbirth; Diseases of mother, fetus and pregnancy; Economic aspects; Expenditures; Factors; Female; Gestational Age; GNP; Gross National Product; Gynecology. Andrology. Obstetrics; Health care expenditures; Health Services Research; Hospital costs; Hospital Costs - statistics & numerical data; Humans; Infant, Newborn; Intensive care; Intensive Care, Neonatal - economics; Length of stay; Length of Stay - economics; Lung diseases; Medical sciences; Morbidity; Multiple births; Obstetric Labor, Premature - complications; Obstetric Labor, Premature - economics; Obstetrics and Gynecology Department, Hospital - economics; Pharmacy; Pregnancy; Pregnancy. Fetus. Placenta; Premature birth; Public health; Respiratory distress syndrome; Respiratory therapy; Twins; Variance analysis
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.86.6.809

This study evaluated the extent to which morbidity and costs at birth were associated with plurality, gestational age, and birth-weight with a sample of twins from a large urban hospital. Each twin infant was matched to two singleton infants (control [ctrl]-singletons) for payor status and race, and to one singleton infant (gestation [ga]-singleton) for payor status, race, and gestational age; after exclusion of infants who were transferred, the study population included 111 twins, 242 ctrl-singletons, and 106 ga-singletons. Data were stratified by five gestational categories and compared across study groups. Outcomes included birthweight, neonatal diagnoses, infant length of stay, infant costs per day, and total infant and total birth costs. Total birth costs ranged from $280,146 at 25 to 27 weeks to $9,803 at 39 to 42 weeks, decreasing with advancing gestation to means of $88,891 (twins), $43,041 (ga-singletons), and $9,326 (ctrl-singletons). Twins did not differ from either group of singletons in prematurity-related diagnoses, length of stay, or costs until after 34 weeks' gestation. In this sample, prematurity, not plurality, was the predominant cost factor at birth. Compared with singletons, twins experienced increased morbidity and associated costs after 38 weeks' gestation.