Paper
Sunday, November 4, 2007
175
The COPE NICU Program for Parents and Preterm Infants: Direct Healthcare NICU Costs and Savings
Nancy Fischbeck Feinstein, PhD1, Bernadette Mazurek Melnyk, PhD, RN, CPNP, FAAN2, Hugh Crean, PhD1, and Eileen K. Fairbanks, MS, RN, PNP1. (1) School of Nursing, University of Rochester, Rochester, NY, USA, (2) Arizona State University College of Nursing & Healthcare Innovation, Phoenix, AZ, USA
Purpose: Over 500,000 premature births occurred in the US in 2004, at a rate of 1 in 8 infants or 12.5 percent of all live births (March of Dimes, 2006). The costs associated with a neonatal intensive care unit (NICU) stay and increased medical utilization by these infants are exorbitant. The purpose of this study was to examine the incremental cost of development and implementation of this NICU educational-behavioral intervention program (COPE) as compared to a control program, from the health-care sector perspective (i.e., direct health care costs).
Methods: Mothers of 246 low-birth-weight (LBW) infants were randomized to COPE or control conditions. Program production and implementation costs during the NICU stay were examined. Length of NICU stay was measured in days. To estimate the expenses associated with days spent in the NICU, the number of days was multiplied by a cost of $1,250 per day (a conservative cost estimate reflecting median treatment costs which include accommodation and ancillary costs).
Results: The cost of the COPE program through NICU discharge was approximately $136 per child (n = 138), which included the sum of production and implementation costs. Direct healthcare costs savings per infant related to NICU hospitalization based on the mean 4 day shortened LOS for the COPE group and a conservative cost savings/day estimate of $1,250/NICU day would be $5,000. Therefore, based on these estimates, the net direct health care cost savings per child through NICU discharge after deducting the cost of the intervention would be $4,864. Further subgroup analyses for LOS based on birthweight revealed that COPE infants <1500 grams had an even shorter NICU length of stay (n=90, 8.3 days) which could result in greater savings.
Conclusions and Implications: Implementation of COPE could result in considerable direct health care cost savings in the NICU.