Health Services/Policy
Trends in adverse perinatal outcomes and associated hospitalisations and healthcare costs between birth and early childhood in Northern Territory, Australia: A two-decade population-based study Tsegaye Haile* Tsegaye Haile Gavin Pereira Richard Norman Gizachew A. Tessema
Background: Perinatal morbidity, including preterm birth (PTB), small-for-gestational-age (SGA), and low birthweight (LBW) continue to impact children’s health and healthcare demands in Northern Australia. We investigated the incidence, hospitalisation and Emergency Department (ED) presentations of these outcomes, and its associated healthcare costs up to age five from a health system perspective.
Methods: We used a retrospective cohort data of births from July 1, 2000, to June 30, 2016, from the Perinatal Trends dataset linked to the Inpatient and ED activity datasets. and cost-weight data. We measured healthcare costs using direct medical and non-medical costs and examined the trends across years and over childhood. All costs were standardised to Australian dollars (AUD, as of June 2024). To identify the drivers of cost, we used a Generalized Additive Model with a gamma distribution and log link function.
Findings: A total of 31,183 births were linked to hospitalisation and 42,174 to ED presentation. We found 8·7% PTB, 12·8% SGA and 7·7% LBW children. The mean hospitalisation per child was 3.1, and ED presentations were 3.0 over the first five years, with an increasing trend over the last decade, while the length of hospital stays decreased. The median hospitalisation cost per preterm child was AUD7,758(IQR: AUD 5,212 to 11,601), and the ED presentation cost was AUD 775(IQR: AUD 590 to 1,016) in the first five years. For SGA, the median hospitalisation cost was AUD 6,139 (IQR: AUD 4,278 to 8,639) and ED cost was AUD 720 (IQR: AUD 552 to 948). We observed higher costs of hospitalisations and ED presentations in later cohorts, while individual costs decreased as the child aged. Remoteness, Indigenous status, extremely low gestational age and birthweight, and length of hospital stay were the main drivers of costs.
Interpretation: The burden of adverse perinatal outcomes is increasing in the Northern Territory, imposing higher healthcare utilisation and costs, particularly due to extended hospital stays. Vulnerable populations, including Indigenous children and those in remote areas, incur higher healthcare costs than the average. Addressing this dual health and economic burden is crucial for cost savings and improving long-term well-being.