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Economic consequences of preterm birth: a systematic review of the recent literature (2009–2017)
  1. Stavros Petrou1,
  2. Hei Hang Yiu1,
  3. Joseph Kwon2
  1. 1 Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
  2. 2 School of Health and Related Research, The University of Sheffield, Sheffield, UK
  1. Correspondence to Professor Stavros Petrou, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; s.petrou{at}


Background Despite extensive knowledge on the functional, neurodevelopmental, behavioural and educational sequelae of preterm birth, relatively little is known about its economic consequences.

Objective To systematically review evidence around the economic consequences of preterm birth for the health services, for other sectors of the economy, for families and carers, and more broadly for society.

Methods Updating previous reviews, systematic searches of Medline, EconLit, Web of Science, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase and Scopus were performed using broad search terms, covering the literature from 1 January 2009 to 28 June 2017. Studies reporting economic consequences, published in the English language and conducted in a developed country were included. Economic consequences are presented in a descriptive manner according to study time horizon, cost category and differential denominators (live births or survivors).

Results Of 4384 unique articles retrieved, 43 articles met the inclusion criteria. Of these, 27 reported resource use or cost estimates associated with the initial period of hospitalisation, while 26 reported resource use or costs incurred following the initial hospital discharge, 10 of which also reported resource use or costs associated with the initial period of hospitalisation. Only two studies reported resource use or costs incurred throughout the childhood years. Initial hospitalisation costs varied between $576 972 (range $111 152–$576 972) per infant born at 24 weeks’ gestation and $930 (range $930–$7114) per infant born at term (US$, 2015 prices). The review also revealed a consistent inverse association between gestational age at birth and economic costs regardless of date of publication, country of publication, underpinning study design, follow-up period, age of assessment or costing approach, and a paucity of evidence on non-healthcare costs. Several categories of economic costs, such as additional costs borne by families as a result of modifications to their everyday activities, are largely overlooked by this body of literature. Moreover, the number and coverage of economic assessments have not increased in comparison with previous review periods.

Conclusion Evidence identified by this review can be used to inform clinical and budgetary service planning and act as data inputs into future economic evaluations of preventive or treatment interventions. Future research should focus particularly on valuing the economic consequences of preterm birth in adulthood.

  • preterm birth
  • health economics
  • costing

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  • Contributors SP designed this study, reviewed the evidence from all contributing studies, wrote the article and acts as guarantor. HHY and JK screened all titles and abstracts. HHY also reviewed the evidence from all contributing studies.

  • Funding The Warwick Clinical Trials Unit, University of Warwick, benefited from facilities funded through the Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform, with support from Advantage West Midlands. SP receives support as an NIHR Senior Investigator (NF-SI-0616-10103). SP also receives funding from the European Union’s 2020 research and innovation programme, RECAP, under grant agreement number 733280.

  • Disclaimer The views contained within this paper are those of the authors and not necessarily of the funders.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.