Prediction and Cost of Futility in the NICU

In Acta Pediatrica, William Meadow and colleagues defend against criticism of NICU expense.  In contrast to adult ICU, NICU care is remarkably well-targeted to patients who will survive.  "Only 7% of overall NICU expenses are spent on nonsurvivors."  In contrast, nearly 40% of MICU costs are devoted to patients who will die before hospital discharge.  Moreover, it seems difficult to reduce this already-low number given limited prognostic predictive power.





This argument is similar to one that Meadow and Lantos made in a contribution to a 2011 symposium I edited for the Journal of Law, Medicine, and Ethics.

Providing care for a baby born at 24 weeks of gestation in a neonatal intensive care unit (NICU) is one of the most expensive medical treatments in the United States today. The cost can easily run over $300,000 for one baby. Furthermore, many extremely premature babies who survive are left with chronic diseases or disabilities that require further medical expenses and other specialized services throughout childhood or throughout life. When all these expenditures are totaled up, it can seem that neonatal intensive care is just not worth it. Concerns about the cost-effectiveness of NICUs have led to persistent critical scrutiny of these specialized units by physicians, economists, and epidemiologists. These analysts have examined NICUs and the patients in them in order to determine whether there are subpopulations of babies for whom neonatal intensive care is so demonstrably ineffective or so costly that it should not be provided. Such examinations have been carried out in many different countries, at many times over the last 30 years, and have analyzed outcomes for babies by gestational age, birthweight, and illness severity.