A systematic review of medication costs associated with preterm infants

Abstract Background Preterm birth significantly affects neonatal and child health through various severe complications, contributing to high neonatal and under-5 mortality rates globally. While the overall medical costs associated with preterm birth have been explored, comprehensive studies specifically focused on the medication costs related to health conditions arising from preterm birth remain limited. Methods Systematic searches were conducted across MEDLINE, Embase, Web of Science, International HTA database and Pediatric Economic Database Evaluation Project using broad search terms for literature published before May 31, 2024. Included studies, published in English, reported the medication costs of preterm birth individuals from birth to age 17 using primary evidence, which were then categorised according to corresponding life stages. Collected medication costs were converted to U.S dollars for the financial year in which the costs were reported based on purchasing power parities and inflated to 2025 U.S. dollar values. Results The literature search yielded 5,269 articles. Of these, 42 articles satisfied criteria and were incorporated into this systematic review. Among these articles, 38 papers reported medication costs in infancy (under age 1), 3 papers reported costs in childhood (age 1 to age 12) and 1 paper reported costs across infancy and childhood. The review found that medication costs for common complications varied widely, with higher costs associated with severe conditions and specific treatments. The highest medication cost in this study was observed in patients with chronic lung disease treated with nitric oxide for approximately 24 days, totalling $20,705 per patient (2025 USD). Additionally, costs during childhood showed variability influenced by gestational age at birth and respiratory disease history. In infancy, medication costs typically accounted for less than 15% of total healthcare expenditure in studies reporting both components; childhood evidence was limited and suggested a smaller share of total costs. Conclusions This review documented wide variation in medication costs among preterm infants, with the highest costs linked to selected conditions and treatments. Childhood evidence was limited to three heterogeneous studies, and no adolescent data were identified. Future economic evaluations should derive medication-cost parameters from reliable primary sources. PROSPERO registration number CRD42024599548.