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Economic Impact of Early Use of Caffeine In Preterm Infants of ≤29 Weeks Gestation

Friday, October 19, 2012
Room R02-R05 (Morial Convention Center)
Pradeep Alur1, Vishwarath Bollampalli1, Theodore Bell2 and Jonathan Liss1, (1)Neonatology, WellSpan Health, York, PA, (2)Emig Research Dept, Wellspan Heath, York Hospital, York, PA

Economic Impact of Early Use of Caffeine in Preterm Infants of ≤29 Weeks Gestation.

Background: Caffeine, a non-specific adenosine receptor (A1AR) antagonist, has been shown to be effective in treating apnea of prematurity. Recently, the CAP trial showed that caffeine when used for prevention of apnea reduced the incidence of oxygen requirement at 36 weeks corrected gestational age (CLD). However, the economic impact of caffeine on cost of hospitalization, when started by 3 days of age in preterm infants is largely unknown.

Purpose: To determine the impact of caffeine started at ≤ 3 days of age in infants ≤29 weeks of gestation on total cost of hospitalization.

Methods: A retrospective chart review of all the infants born ≤29 weeks of gestation from 2007 to 2011 at our institution who survived until discharge or 36 weeks corrected gestational age. Birth weight, gestational age, sex, day of life when caffeine was started, duration of mechanical ventilation (DV), PDA, infection, CLD, PVL, NEC and ROP were obtained and analyzed. Average of all the caffeine levels (ACLs) during therapy was determined. Actual total costs and charges in dollars incurred for each patient were obtained from the patient accounting data and were compared between the study group (caffeine started ≤3 days of life [CDOL3]) and the control group (caffeine started ≥4 days of life [CDOL4]).

Results: We reviewed 222 charts; 199 met the inclusion criteria, and 23 were omitted due to death or transfer before 36 weeks corrected gestational age.. Mortality was 3.1% in CDOL3 vs 15.2% in CDOL4 group (P=<0.002). CLD (18% vs 33.8%, P= 0.012), LOS (71.6 days (SD 27.4) vs 86.7 (SD 48.6, P=0.006), and DV were significantly less in CDOL3 group (13.4, SD 21.4) compared to CDOL4 (28.6, SD 35.4) P= 0.005.

Patient Demographics.

We compared the actual total costs per patient based on when caffeine was started and ACLs.

We also analyzed the correlation between ACLs and total charges for the stay. There was a significant inverse relationship of caffeine levels with charges (P value =<0.001). This resulted in total savings of $ 7,515,568.44 in our study group, when caffeine was initiated by CDOL3 of life. The number needed to treat with caffeine to prevent one case of CLD was 3.6 (p=0.005. 95% CI= 2.3-7.5).

Conclusions: There is a significant cost savings associated early use of caffeine, which strongly justifies initiation of caffeine by 3 days of age in this vulnerable population. ACLs  > 15 may also contribute to cost savings. Preterm infants of ≤29 weeks of gestation treated with caffeine by CDOL3 of life have significantly shorter LOS, DV and have significantly less CLD. Further study is warranted to confirm economic impact of caffeine levels in preterm infants.