Background: Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors.\nRecent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the\ndifferent interventions that might be covered by the program, including neonatal intensive care. The purpose of this study\nwas to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico.\nMethods and Findings: A cost-effectiveness analysis was conducted using a decision analytic model of health and\neconomic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican\nvital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the\npublished literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World\nHealth Organization price lists, supplemented with published studies from other countries as needed. The model estimated\nchanges in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years\n(DALYs), and incremental cost-effectiveness ratios (ICERs) for neonatal intensive care compared to no intensive care.\nUncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic\nsensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24ââ?¬â??26, 27ââ?¬â??29, and 30ââ?¬â??33 weeks\ngestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per\ninfant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of\nneonatal intensive care at 24ââ?¬â??26, 27ââ?¬â??29, and 30ââ?¬â??33 weeks were US$1,200, US$650, and US$240, per DALY averted,\nrespectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses.\nConclusions: Incremental cost-effectiveness ratios for neonatal intensive care imply very high value for money on the basis\nof conventional benchmarks for cost-effectiveness analysis.
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