The Margins of Viability

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Here's a talk for the LSE Health Economics Study Group today.

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  • Very interesting and well presented!! You did a great job my dear! Thank you for sharing ...
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  • Shocking and therefore most useful to see it set out so clearly and uncontravertibly.

    Well done all of you!

    Sadly I have recognized that as we now have so many people who can calculate, we can and for certain purposes, must price human life. Yet the explicit need to do so is hedged and it is hidden under fudge. Much capitasl is wasted as a result and more peole suffer due to misallocation of investment.

    Hard decisions are taken daily yet many more are specifically not taken for no good reason, wasting other opportunities for more lives.

    Expect a storm!!
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The Margins of Viability

  1. 1. The Margins of Viability Stephen Kinsella** Dominic Trepel** Fiona McElligott * Roy K Philip* *Regional Maternity Hospital **University of Limerick
  2. 2. What we did. Question: How much did it cost to keep 1 ELBW infant alive for 212 days in hospital? Answer: 611,000 euros. Method: calculation of total costs from highly detailed data set gathered from patient, painstaking attention to details of the case. Marginal costs calculated as TC = €611,497,38, 1 week of extra life cost €8531.00, Fixed cost: €28,755.00. Conclusion: very precise data implies much larger cost than other US/UK studies have found.
  3. 3. Background Our study examines the cost of care in the case of an extremely low birth weight (ELBW) infant. Birth at 24 weeks: the marginal case Many procedures required to keep patient alive 212 days in hospital Q: How much did this cost?
  4. 4. 176 variables Data 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions 83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head, abdomen, heart) 940 laboratory investigations 2 x National Neonatal Transport Transfer Family’s Time, Equipment Maintenance, Refurbishment, and more...
  5. 5. Method Assigned unit costs to chart variables. Calculated Fixed, Variable, Total and Marginal Costs daily as TC: Total T Ct Cost = M Ct Qt−1 Q: Extra day of life
  6. 6. Day 19 Fungal Sepsis, Day 202 Transfer to Crumlin RSV Vaccination
  7. 7. Total Cost TC = €611,497,38 1 week: cost €8531.00 Fixed cost: €28,755.00
  8. 8. Cost reduction as we approach discharge
  9. 9. Conclusions Very precise data implies increased cost TC, MC substantially larger than UK, US estimates. Possible benchmark case for a larger study of neonates in midwest region
  10. 10. Problems/Next Steps 1. Clearly, econometrics inappropriate, MLE/ Spline estimation to follow 2. Problem of generalisation from 1 case 3. Clear break from levels reported

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