Health care costs during the first 20 years of life in infants with hypoxic-ischemic encephalopathy in Brazil: estimated economic benefits generated by the use of therapeutic hypothermia and brain monitoring

Abstract

Background: Hypoxic-ischaemic encephalopathy (HIE) is a leading cause of long-term disability. Infants with HIE may require specific lifelong care, representing a devastating social and economic impact. Therapeutic hypothermia (TH) has been proven to be a safe and effective treatment; however, its potential economic impact associated with continuous electroencephalographic monitoring is still unknown in Brazil. This study aimed to evaluate the potential economic benefits provided by TH and continuous electroencephalographic monitoring in the first 20 years of life in infants with HIE in Brazil. 

Methods: A resource utilization questionnaire about healthcare of infants with HIE was answered by 57 pediatricians and neonatologists in all five regions of Brazil. This data was used to calculate an annual weighted average of patient management costs according to the presence or degree of disability, considering only directly related health costs. A mathematical calculation was performed considering local incidence of HIE and the number of live births per year. Rates of death and survival for different levels of disability and the effect of TH on these outcomes were estimated from the two most relevant randomized controlled trials on TH.

Results: There was an approximately 26-fold increase in spending when the severe disability group was compared to the no disability group (p-value<0.0001, ANOVA-Bonferroni). The estimated total cost of patients with no disability, mild, moderate, and severe disability is US$ 6,808.53, US$ 32,208.43, US$ 105,791.78 and US$ 175,698.58, respectively, and the estimated costs related to the use of TH and neuromonitoring were estimated in US$ 2,824.00. Considering a weighted average between TOBY trial and NICHD trial, it is estimated annual savings of US$ 39,700,000-79,401,000.

Conclusions: This study estimated a significant increase in the costs associated with the degree of disability and a positive impact of TH throughout the first 20 years of life.