Much of the literature on the rates of receipt of special education by newborn status has focused on LBW infants, particularly VLBW and extremely-low-birth-weight infants, and has not been estimated from population-based samples (Pinto-Martin et al., 2004). In a 9-year follow-up of a cohort of 1,105 infants born between September 1984 and June 1987 in central New Jersey, both VLBW and birth at a gestational age of less than 28 weeks were found to be significantly associated with the receipt of special educational services, with the odds ratio for those born extremely preterm relative to those born term being higher than the odds ratio for those born VLBW relative to those born with normal BWs (Pinto-Martin et al., 2004). Although a review of the literature revealed a few studies that have made estimates of the costs of special education associated with LBW (Zupancic, 2006), little research on the special education costs specifically associated with preterm birth has been conducted to date. One multivariate study found that LBW added $1,240 (1989-1990 dollars) per child to the annual cost of schooling for children ages 6 through 15 years born with birth weights of less than 2,500 grams (Chaikand and Corman, 1991). This translates into $2,009 in 2005 per LBW child when the employee compensation index for primary and secondary school employees is applied to adjust for inflation between 1989-1990 and 2005.
As with the cost of medical care beyond age 5 years, an estimate of the special education costs due to premature birth was made on the basis of the incremental special education costs specific to four developmental disabilities that have a higher prevalence among those born pre-term: MR, CP, VI, and HL. It is noted that the increased use of infertility treatment may lead to special education costs due to its effect on preterm birth via multiple gestations. To the extent that preterm birth associated with multiple gestations leads to the four disabilities that are included in these estimates, such costs are included. The estimates reflect the receipt of services from ages 3 to 18 years, discounted back to the year of birth at a 3 percent rate. The estimates were based on data from CDC (2004c) and unpublished tabulations from MADDSP, as described above. The rate of receipt of special education services by developmental disability was based on the distribution from MADDSP. Allocation among federal special education handicap categories was based on the primary disability for those with MR, VI, and HL and was based on estimates
2 This calculation assumed the same percentage distribution of services across the first 3 years of life for children born preterm as the distribution of mean costs of EI services for all children. All costs beyond the first year of life were discounted at a 3 percent rate back to the year of birth. Costs were adjusted for the difference in the cost of living between Massachusetts and the nation as a whole and for inflation, gauged by the Employment Cost Index, between 2003 and 2005. Only preterm children surviving infancy were assumed to receive EI services.
from Waitzman et al. (1996) for CP. Costs for special education were taken from the Special Education Expenditure Project (Chambers et al., 2003). Estimates were incremental, that is, costs above and beyond what would have been spent on regular education. For each case associated with preterm birth, estimated lifetime special education costs were $102,410, $81,655, $125,811, and $92,020 for those with MR, CP, VI, and HL, respectively. In terms of cohort results, updated to 2005 costs, special education for individuals with these four developmental disabilities added an estimated $2,237 per preterm survivor to the overall lifetime cost associated with preterm birth. This translates into a societal cost of $1.1 billion for special education in association with preterm birth.
There is only about a 10 percent difference between the inflation-adjusted estimate per LBW infant from an earlier study (Chaikand and Corman, 1991) and the $2,237 per infant estimate for preterm birth provided here. Although the similarity is intriguing, there were distinct differences in the methodologies and populations underlying the methods used to obtain these estimates. The estimate was for services provided to children who had been born with LBWs from ages 6 to 15 years, whereas the current estimate was for special education services provided to children who had been born with LBWs from ages 3 to 18 years. The estimate provided here, more importantly, is based only on a subset of disabling conditions among children born preterm for whom special education is provided. In that respect, these special education cost estimates are conservative proxies of the full cost of special education services provided to those born preterm. As discussed in Chapter 11, the receipt of special education services is quite prevalent among children born preterm, beyond those with the specific disabilities. However, these costs could not be tabulated.
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