Health economic evaluations of programs reducing preterm birth: A scoping review

Background: Preterm birth has lifelong implications, placing a burden on individuals, families, communities and the health system. While several interventions to reduce preterm birth have been economically evaluated, no scoping review has been undertaken. 

Objective: To conduct a scoping review of economic evaluations of interventions that have reduced preterm birth, identify gaps in the literature and inform future health care providers and researchers on the economic value of preterm birth reduction interventions.

Methods: Databases such as PubMed, Cumulative Index to Nursing and Allied Health Literature, EBSCO, Medline (OVID), EMBASE, NHS Health Technology Assessment, the Cost-Effectiveness Analysis Registry, and the NHS Economic Evaluation Database and grey literature were comprehensively searched for economic evaluations of interventions that reduced preterm birth conducted since 2000. Items included: preterm birth reduction, intervention, method of economic evaluation, time-horizon of analysis, study population, perspective of evaluation, effectiveness, and costs. Review processes were undertaken by two reviewers, and disagreements were resolved by the larger team. 

Results: Fifteen publications met the inclusion criteria, including pharmacological interventions (5), telemedicine (1), diagnostic procedures (2), public and community health (2), prenatal care and nutrition (2), father's involvement (1), doula care (1) and a comprehensive maternity service redesign (1). Variations were observed in study design, time-horizon, study population and method of evaluation. Most studies (n = 13) adopted either a healthcare payer, provider, or system perspective. Shorter time horizons for analysis were adopted in all studies, except one that conducted a lifetime economic evaluation. All included interventions, except one, were found to be cost effective, cost-beneficial or led to cost-savings. 

Conclusion: Despite preterm birth placing a high economic burden on health systems and society, we found a dearth of long-term economic evaluations of prevention and reduction initiatives. Future research on preterm birth reduction initiatives should include economic evaluations.