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The Margins of Viability

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Here's a talk for the LSE Health Economics Study Group today.

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The Margins of Viability

  1. 1. The Margins of Viability Stephen Kinsella** Dominic Trepel** Fiona McElligott * Roy K Philip* *Regional Maternity Hospital **University of Limerick
  2. 2. What we did. Question: How much did it cost to keep 1 ELBW infant alive for 212 days in hospital? Answer: 611,000 euros. Method: calculation of total costs from highly detailed data set gathered from patient, painstaking attention to details of the case. Marginal costs calculated as TC = €611,497,38, 1 week of extra life cost €8531.00, Fixed cost: €28,755.00. Conclusion: very precise data implies much larger cost than other US/UK studies have found.
  3. 3. Background Our study examines the cost of care in the case of an extremely low birth weight (ELBW) infant. Birth at 24 weeks: the marginal case Many procedures required to keep patient alive 212 days in hospital Q: How much did this cost?
  4. 4. 176 variables Data 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions 83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head, abdomen, heart) 940 laboratory investigations 2 x National Neonatal Transport Transfer Family’s Time, Equipment Maintenance, Refurbishment, and more...
  5. 5. Method Assigned unit costs to chart variables. Calculated Fixed, Variable, Total and Marginal Costs daily as TC: Total T Ct Cost = M Ct Qt−1 Q: Extra day of life
  6. 6. Day 19 Fungal Sepsis, Day 202 Transfer to Crumlin RSV Vaccination
  7. 7. Total Cost TC = €611,497,38 1 week: cost €8531.00 Fixed cost: €28,755.00
  8. 8. Cost reduction as we approach discharge
  9. 9. Conclusions Very precise data implies increased cost TC, MC substantially larger than UK, US estimates. Possible benchmark case for a larger study of neonates in midwest region
  10. 10. Problems/Next Steps 1. Clearly, econometrics inappropriate, MLE/ Spline estimation to follow 2. Problem of generalisation from 1 case 3. Clear break from levels reported

Here's a talk for the LSE Health Economics Study Group today.

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