Cost of clinician-driven tests and treatments in very low birth weight and/or very preterm infants

Objective: To rank clinician-driven tests and treatments (CTTs) by their total cost during the birth hospitalization for preterm infants. Study design: Retrospective cohort of very low birth weight (<1500?g) and/or very preterm (<32 weeks) subjects admitted to US children’s hospital Neonatal Intensive Care Units (2012–2018). CTTs were defined as pharmaceutical, laboratory and imaging services and ranked by total cost. Results: 24,099 infants from 51 hospitals were included. Parenteral nutrition ($85M, 32% of pharmacy costs), blood gas analysis ($34M, 29% of laboratory costs), and chest radiographs ($18M, 31% of imaging costs) were the costliest CTTs overall. More than half of CTT-related costs occurred during 10% of hospital days. Conclusions: The majority of CTT-related costs were from commonly used tests and treatments. Targeted efforts to improve value in neonatal care may benefit most from focusing on reducing unnecessary utilization of common tests and treatments, rather than infrequently used ones.