Original Article
Hospital and ED charges for spina bifida care in the United States between 2006 and 2014: Over $2 billion annually.

https://doi.org/10.1016/j.dhjo.2019.01.007Get rights and content

Abstract

Background

More children with spina bifida (SB) are surviving into adulthood. Unfortunately, little data exist regarding the economic implications of modern SB care.

Objective

We examined economic data from two national databases to estimate the annual nationwide hospital and emergency charges of SB from 2006–14.

Methods

We analyzed the 2006–2014 Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS). SB patients were defined using ICD-9-CM codes. Demographic and charge data were obtained from each database. Multiple imputation was used to estimate missing data (1.6% for NIS and 22% in NEDS). The principal outcomes were mean, median, and total charges for encounters each year.

Results

There were 725,646 encounters for individuals with SB between 2006 and 2014. The average age of captured SB patients who were admitted to a hospital or seen in an ER was 29 years. In 2014, the median charge for inpatient encounters was $31,071 (IQR: $15,947, $63,063) and for ER encounters was $2407.02 (IQR: $1321.91, $4211.35). In total, the sum of charges from all SB-related admissions in 2014 was $1,862,016,217 (95% CI: $1.69 billion, $2.03 billion), while the sum of charges of all SB-related ER encounters in 2014 was $176,843,522 (95% CI: $158 million, $196 million). There was a steady increase in charges over the study period.

Conclusion

Charges for SB-related inpatient and emergency care in the US in 2014 was in excess of $2 billion in contrast to $1.2 billion in 2006, after adjusting for inflation; this is an impressively high figure for a relatively small number of patients.

Section snippets

Data source

The 2006 to 2014 NIS and NEDS databases from the Healthcare Cost and Utilization Project (HCUP) were used. All analyses utilized HCUP data distributed by CD-ROM or digital download. The NIS approximates a 20-percent stratified sample of all discharges from U.S. community hospitals, excluding rehabilitation and long-term acute care hospitals. Weights are applied to the sample to make national level inferences.10 NEDS approximates a 20% sample of hospital-based EDs in the US. All ED visits are

Demographics

There were 725,646 encounters for individuals with SB identified in NIS and NEDS between 2006 and 2014, with 430,530 (59.3%) being ED encounters (Table 1). The mean age of both inpatient (29 years; 95% CI: 28.3, 29.7) and ED (29 years; 95% CI: 28.6, 29.8) encounters were similar. The rate of females in either setting was approximately 57%. Public insurance (63.2% in NIS vs 66.4% NEDS) was the most common payer type. Q1 (29.3% in NIS vs 30.5% in NEDS) and Q2 (27.3% in NIS vs 28.6% in NEDS) were

Discussion

To our knowledge, this study represents the most comprehensive inpatient and emergency department-based assessment of the economic impact of SB in the United States to date. Dicianno and Wilson (2010) reported a mean inpatient charge of $28,918 and a total sum of $1.08 billion for inpatient admissions in 2005. Our study attempted to build off this finding by documenting the trend of hospital and ED charges over time while also imputing values to improve statistical inference. For our data set,

Conclusion

Based on this inpatient and ER data, hospital charges for management of SB was estimated to be $2.04 billion in 2014 alone in contrast to $1.2 billion in 2006. This figure may be an under-estimate of the economic burden of SB, as it excludes non-ER outpatient SB management and societal costs.

Conflicts of interests

None.

Disclosure

Third World Congress of Spina Bifida in San Diego, CA on March 16, 2017.

Funding source

None.

References (23)

  • Healthcare Cost and Utilization Project. NEDS overview. [cited 2017; Available from:...
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