I recently read an article with the tag-line;”With every case being so different, economics should not dominate intervention policy for premature babies’ survival”. Naturally I thought “this can’t be true” and felt the need to analyse this further.
The article discusses a BBC programme, which I unfortunately missed, about babies born 23 weeks premature. To quote the article: “an NHS commissioner, Dr Daphne Austin, argued that keeping babies alive at 23 weeks does more harm than good and that the money, £10m a year for about 350 babies, would be better spent elsewhere.” Time to look at the numbers.
According to these figures, each 23 week premature baby costs just over £28,500 to keep alive. The article refers to a study that finds that 11% of these babies survive, half of which are free of significant disability. The cost per surviving baby is therefore just under £260,000. Now, let’s add some EQ-5D scores. Let’s say that the half with serious disability have an EQ-5D score of just 0.2, and those without have an EQ-5D score of 0.5. Let’s say they all survive for 20 years. Saving the babies therefore represents an expected QALY gain of 7 QALYs. That gives us a cost-per-QALY of just over £37,000; not so inefficient. I don’t know the clinical literature in this field, but I would suspect that these children live for an average of over 20 years, and that they possibly have a better quality of life than assumed here.
So, if these children live for an average of 40 years we are looking at a cost-per-QALY of just over £18,000; a bargain. Non-economists tend to confuse our field with accountancy and book-balancing. I hope that this brief analysis will help show how we really should be allowing economics to dominate intervention policy for premature babies! I only hope that this area will see more economic analysis in the future.
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