A new study published by the CDC on January 20, 2017, reported that, in the United States, major structural or genetic birth defects affect approximately 3% of live births and are responsible for 20% of infant deaths. Birth defects can affect persons across their lifespan and are the cause of significant lifelong disabilities. The CDC estimated the annual cost of birth defect–associated hospitalizations in the United States, both for persons of all ages and by age group. Birth defect–associated hospitalizations had disproportionately high costs, accounting for 3% of all hospitalizations and 5.2% of total hospital costs. The estimated annual cost of birth defect–associated hospitalizations in the United States in 2013 was $22.9 billion. Estimates of the cost of birth defect–associated hospitalizations offer important information about the impact of birth defects among persons of all ages on the overall health care system and can be used to prioritize prevention, early detection, and care.
The total weighted cost for birth defect–associated hospitalizations was $22,946,158,457, representing 5.2% of total costs for all hospital discharges. The costs for birth defect–associated hospitalizations were highest among patients under one year old ($8,901,015,375) compared with other age groups. Among admissions of all patients under one year old, birth defect–associated hospitalizations represented 35% of total costs. For patients between the ages of one and five years old, the cost of birth defect–associated hospitalizations was $1,532,487,122, representing 6.7% of total birth defect–associated hospitalization costs. The median cost for birth defect–associated hospitalizations was lowest among patients aged under one year old ($2,126) and highest among patients over 65 years old ($13,270).
Among the organ systems considered, cardiovascular defects accounted for the largest percentage of birth defect–associated hospitalizations (14%), and the highest total cost, approximately $6.1 billion (26.6% of total birth defect–associated hospitalization costs). Within cardiovascular defects, critical congenital heart defect–associated hospitalizations had the highest mean and median cost of the birth defect categories considered ($79,011 and $29,886, respectively). Central nervous system defects accounted for the second most frequent birth defect–associated hospitalizations (6.2%), with a total cost of approximately $1.7 billion. Among noncardiovascular defects, eye defect–associated hospitalizations had the highest mean cost ($44,441), and ear defects had the highest median cost ($11,349). The specific birth defect with the highest median hospitalization cost was interrupted aortic arch (median = $76,109).
Among birth defect–associated hospitalizations, 11.8% had a primary birth defect International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code, the U.S. health system’s adaptation of an international standard list of six-character alphanumeric codes to describe diagnoses. The total estimated cost for those hospitalizations was $5,043,781,895, accounting for 1.1% of total hospital costs and 22% of birth defect–associated hospitalization costs when all discharge diagnoses were included. Among the birth defect types examined using only the primary birth defect ICD-9-CM codes, hypoplastic left heart syndrome had the highest mean cost ($164,994) and interrupted aortic arch had the highest median cost ($119,303).
After excluding discharges with ICD-9-CM or Diagnosis Related Group codes indicating preterm birth, the total estimated cost for birth defect–associated hospitalizations was $18,884,865,845 or 82.3% of total costs of all birth defect–associated discharges.
The findings in this report are subject to at least five limitations. First, use of all diagnosis codes might have overestimated costs because the coded birth defect might have been incidental to the reason for the hospitalization. Conversely, birth defects that influence conditions leading to hospitalization might be less likely to be coded as a person ages. Second, the primary analysis included preterm infants, who have higher associated hospitalization costs, potentially leading to an overestimate of cost. Although preterm birth is more common in infants with birth defects, the extent to which hospitalization costs are attributable to preterm birth, rather than the birth defect, cannot be estimated with these data. Third, some children had more than one birth defect diagnosis; attributing the cost of hospitalization to each defect independently in these children might have resulted in an overestimate of the cost of one or more of the individual defects. Fourth, although the data used in this report are routinely used for research, their source data were originally created for billing purposes and diagnoses are not validated, which might have led to an over- or underestimate of average costs. Finally, the cost-to-charge ratios used in this analysis were based on aggregated hospital data and were not specific to the departments or treatments more likely to be used for birth defect hospitalization, which might have affected the cost estimate in either direction.
By estimating the cost of birth defect–associated hospitalizations, both researchers and policy makers can be more informed of the impact of birth defects on the health care system and can use this knowledge to motivate change through prevention, early detection, and care throughout the lifespan of affected persons.
See the CDC Report
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