Resuscitation of likely nonviable infants: A cost-utility analysis after the Born-Alive Infant Protection Act

John Colin Partridge, Mya D. Sendowski, Alma M. Martinez, Aaron B. Caughey

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

The purpose of this study was to compare the effects of universal vs selective resuscitation on maternal utilities, perinatal costs, and outcomes of preterm delivery and termination of pregnancy at 20-23 weeks 6 days' gestation. We used studies on medical practices, prematurity outcomes, costs, and maternal utilities to construct decision-analytic models for a cohort of annual US deliveries after preterm delivery or induced termination. Outcome measures were (1) the numbers of infants who survived intact or with mild, moderate, or severe sequelae; (2) maternal quality-adjusted life years (QALYs); and (3) incremental cost-effectiveness ratios. Universal resuscitation of spontaneously delivered infants between 20-23 weeks 6 days' gestation increases costs by $313.1 million and decreases QALYs by 329.3 QALYs; after a termination, universal resuscitation increases costs by $15.6 million and decreases QALYs by 19.2 QALYs. With universal resuscitation, 153 more infants survive: 44 infants are intact or mildly affected; 36 infants are moderately impaired, and 73 infants are severely disabled. Selective intervention constitutes the highest utility and least costly treatment for infants at the margin of viability.

Original languageEnglish (US)
Pages (from-to)49.e1-49.e10
JournalAmerican journal of obstetrics and gynecology
Volume206
Issue number1
DOIs
StatePublished - Jan 2012

Keywords

  • decision-making
  • extreme prematurity
  • nonintervention
  • resuscitation
  • withholding medical care

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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