J. C. Apfeld1,6,7, Z. J. Kastenberg1,2, F. S. Jazi1, C. S. Phibbs4,5, H. C. Lee3,4,6, K. G. Sylvester1,2,3,4 1Stanford University School Of Medicine,Department Of Surgery,Palo Alto, CA, USA 2Stanford University School Of Medicine,Center For Health Policy/Center For Primary Care And Outcomes Research,Stanford, CA, USA 3Lucile Packard Children’s Hospital,Center For Fetal And Maternal Health,Palo Alto, CA, USA 4Stanford University School Of Medicine,Department Of Pediatrics,Palo Alto, CA, USA 5Veterans Affairs Palo Alto Healthcare System,Health Economics Resource Center And Center For Implementation To Innovation,Menlo Park, CA, USA 6Stanford University,California Perinatal Quality Care Collaborative (CPQCC),Palo Alto, CA, USA 7Cleveland Clinic,Department Of General Surgery,Cleveland, OH, USA
Introduction:
Congenital anomalies are one of the leading causes of infant deaths and pediatric hospitalizations, but existing estimates of the associated healthcare costs are either cross-sectional survey studies or economic projections. This study sought to determine the percent of total healthcare expenditures attributable to major anomalies requiring surgery within the first year of life.
Methods:
Utilizing comprehensive California state-wide data from 2008-12 and validated selection criteria, cohorts of major surgery, birth defect, and surgical anomalies were constructed alongside referent groups of non-surgical/non-defect newborns. Cost-to-charge and physician fee ratios were used to estimate hospital and professional costs, respectively. For each cohort, costs were broken down according to admission, birth episode, and first-year-of-life; with additional stratifications by birthweight, gestational age, and involved organ system.
Results:
In total, 68,126 of 2,205,070 infants (3.1%) underwent major surgery (n=32,614) or had a diagnosis of a severe congenital anomaly (n=57,793), comprising $7.7 of $18.9 billion (40.7%) of total first-year of life hospitalization costs/expenditures, $7.1 billion (49.3%) of costs for infants with long birth hospitalizations (5+ days; n=211,791), $5.2 billion (57.8%) of total NICU admission costs. More specifically, infants with surgical anomalies (n=14,296) totaled $3.7 billion (19.6%) at $80,872 per infant. Cardiovascular and gastrointestinal diseases comprised most admission costs secondary to major surgery or congenital anomalies.
Conclusion:
Considering the medical costs of all newborns, infants with congenital surgical anomalies consume a disproportionate cost within the US healthcare system. The care and associated costs of these infants, which are covered to a significant degree by Medicaid, represent a particular focus in an era of healthcare payment reform.
