The cost of prematurity: A case-control study of twins vs singletons

Objectives. This study evaluated the extent to which morbidity and costs at birth were associated with plurality, gestational age, and birthweight with a sample of twins from a large urban hospital. Methods. Each twin infant was matched to two singleton infants (control [ctrl]-singletons) for payor status and race, and to one singleton infant (gestation [ga]-singleton) for payor status, race, and gestational age; after exclusion of infants who were transferred, the study population included 111 twins, 242 ctrl-singletons, and 106 ga-singletons. Data were stratified by five gestational categories and compared across study groups. Outcomes included birthweight, neonatal diagnoses, infant length of stay, infant costs per day, and total infant and total birth costs. Results. Total birth costs ranged from $280 146 at 25 to 27 weeks to $9803 at 39 to 42 weeks, decreasing with advancing gestation to means of $88 891 (twins), $43 041 (ga-singletons), and $9326 (ctrl- singletons). Twins did not differ from either group of singletons in prematurity-related diagnoses, length of stay, or costs until after 34 weeks' gestation. Conclusions. In this sample, prematurity, not plurality, was the predominant cost factor at birth. Compared with singletons, twins experienced increased morbidity and associated costs after 38 weeks' gestation.