This study calculated the total cost of keeping one extremely low birth weight infant alive in the hospital for 212 days to be €611,497.38, with a marginal cost of an extra week of life being €8531. The researchers gathered highly detailed cost data from 176 variables recorded in the patient's case and assigned unit costs to calculate total, variable, fixed, and marginal daily costs - finding that the cost was much higher than estimates from other studies in the UK and US.

1. The Margins of
Viability
Stephen Kinsella** Dominic Trepel**
Fiona McElligott * Roy K Philip*
*Regional Maternity Hospital
**University of Limerick

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. 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. 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. 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. Day 19 Fungal Sepsis, Day 202
Transfer to Crumlin RSV Vaccination

7. Total Cost
TC = €611,497,38
1 week: cost €8531.00
Fixed cost: €28,755.00

8. Cost reduction as we approach discharge

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. 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