Gestational age and hospital admission costs from birth to childhood: a population-based record linkage study in England

Objective To examine the association between gestational age at birth and hospital admission costs from birth to 8 years of age. Design Population-based, record linkage, cohort study in England. Setting National Health Service (NHS) hospitals in England, UK. Participants 1 018 136 live, singleton births in NHS hospitals in England between 1 January 2005 and 31 December 2006. Main outcome measures Hospital admission costs from birth to age 8 years, estimated by gestational age at birth (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks). Results Both birth admission and subsequent admission hospital costs decreased with increasing gestational age at birth. Differences in hospital admission costs between gestational age groups diminished with increasing age, particularly after the first 2 years following birth. Children born extremely preterm (<28 weeks) and very preterm (28-31 weeks) still had higher average hospital admission costs (699 pound (95% CI 419 pound to 919) pound for <28 weeks; 434 pound (95% CI 305 pound to 563) pound for 28-31 weeks) during the eighth year of life compared with children born at 40 weeks (109 pound, 95% CI 104 pound to 114) pound. Children born extremely preterm had the highest 8-year cumulative hospital admission costs per child (80 pound 559 (95% CI 79 pound 238 to 82 pound 019)), a large proportion of which was incurred during the first year after birth (71 pound 997 (95% CI 70 pound 866 to 73 pound 097)). Conclusions The association between gestational age at birth and hospital admission costs persists into mid-childhood. The study results provide a useful costing resource for future economic evaluations focusing on preventive and treatment strategies for babies born preterm.