Postpartum Length of Stay and Newborn Health

A Cost-Effectiveness Analysis

Published in: Pediatrics, v. 111, no. 4, Apr. 2003, p. E316-E322

by Jesse D. Malkin, Emmett B. Keeler, Michael S. Broder, Steven Garber

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.

OBJECTIVE: To evaluate the cost-effectiveness of increasing lengths of brief postpartum hospitalizations. METHODS: A cost-effectiveness model extrapolating from secondary data was used. Social costs in 2000 US dollars were estimated using several sources, including a randomized controlled trial, a retrospective study, and survey data. Life-years saved from reduced infant mortality were estimated from administrative data from Washington State. A total of 113147 singleton newborns who were born in nonmilitary hospitals in Washington State in 1989 or 1990 and had postpartum stays short enough to be affected by length of stay legislation were studied. The cost-effectiveness of increases in postpartum lengths of stay similar to those that would occur if all mothers and singleton newborns used at least the time allotted to them under the federal length of stay legislation was measured. RESULTS: Estimated lower-bound cost per newborn life-year saved was 19 800 dollars (95% confidence interval: 11600-61300 dollars) when only neonatal deaths were considered. The corresponding upper-bound estimate was 94800 dollars (95% confidence interval: 55200-286800 dollars ). The results were very sensitive to assumptions about the discount rate for future life-years and the time from birth during which averted deaths are considered (neonatal deaths, postneonatal infant deaths, or all infant deaths). CONCLUSIONS: At hospitals that do not experience additional capacity costs as a result of increased lengths of stay, lengthening short postpartum stays seems to be more cost-effective than many common health interventions and well below cost-effectiveness thresholds suggested by the literature. Even at hospitals that experience additional capacity costs, the cost-effectiveness of lengthening short postpartum stays seems to be roughly equal to the benchmark of 100000 dollars per quality-adjusted life-year suggested by the literature.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.