Abstract
Objective: To determine the incidence of Neonatal Abstinence Syndrome (NAS) managed in neonatal units, explore healthcare utilisation within this population and estimate the direct cost to the English NHS.
Design: Population cohort study.
Setting: NHS neonatal units in England, using data held in the National Neonatal Research Database.
Participants: Infants born between 2012-2017, admitted to a neonatal unit in England, receiving a diagnosis of NAS (n=6411).
Main outcome measures: Incidence, direct annual cost of care (£, 2016-17 prices), duration of neonatal unit stay (discharge hazard ratio), predicted additional cost of care, and odds of receiving pharmacotherapy.
Results: Of 524,334 infants admitted during the study period, 6,411 had NAS. The incidence (1.6/1000 live births) increased between 2012-2017 (β 0.07 95%CI (0, 0.14)) accounting for 12/1000 admissions and 23/1000 cot days nationally. The direct cost of care was £62,646,661; equivalent postnatal care would have been £34,584,633 over the study period. Almost half of infants received pharmacotherapy (n=2631; 49%) and their time-to-discharge was significantly longer (median 18.2 versus 5.1 days; adjusted Hazard Ratio (aHR) 0.16 95%CI (0.15, 0.17)). Time-to-discharge was longer for formula-fed infants (aHR 0.73 (0.66, 0.81)), and those discharged to foster care (aHR 0.77 (0.72, 0.82)). The greatest predictor of additional care costs was receipt of pharmacotherapy (additional mean adjusted cost of £8,420 per infant).
Conclusions: This population study highlights the substantial cot usage and economic costs of caring for infants with NAS on neonatal units. A shift in how healthcare systems provide routine care for NAS could benefit infants and families whilst alleviating the burden on services.
Design: Population cohort study.
Setting: NHS neonatal units in England, using data held in the National Neonatal Research Database.
Participants: Infants born between 2012-2017, admitted to a neonatal unit in England, receiving a diagnosis of NAS (n=6411).
Main outcome measures: Incidence, direct annual cost of care (£, 2016-17 prices), duration of neonatal unit stay (discharge hazard ratio), predicted additional cost of care, and odds of receiving pharmacotherapy.
Results: Of 524,334 infants admitted during the study period, 6,411 had NAS. The incidence (1.6/1000 live births) increased between 2012-2017 (β 0.07 95%CI (0, 0.14)) accounting for 12/1000 admissions and 23/1000 cot days nationally. The direct cost of care was £62,646,661; equivalent postnatal care would have been £34,584,633 over the study period. Almost half of infants received pharmacotherapy (n=2631; 49%) and their time-to-discharge was significantly longer (median 18.2 versus 5.1 days; adjusted Hazard Ratio (aHR) 0.16 95%CI (0.15, 0.17)). Time-to-discharge was longer for formula-fed infants (aHR 0.73 (0.66, 0.81)), and those discharged to foster care (aHR 0.77 (0.72, 0.82)). The greatest predictor of additional care costs was receipt of pharmacotherapy (additional mean adjusted cost of £8,420 per infant).
Conclusions: This population study highlights the substantial cot usage and economic costs of caring for infants with NAS on neonatal units. A shift in how healthcare systems provide routine care for NAS could benefit infants and families whilst alleviating the burden on services.
| Original language | English |
|---|---|
| Journal | Archives of Disease in Childhood |
| Publication status | Accepted/In press - 8 Jan 2021 |