The Cost of Care for Patients with Myelomeningocele Transitioning to Adulthood
Rano Matta, MD, MSc, MASc1, Joshua J. Horns, MSc2, Glen A. Lau, MD1, Anthony J. Schaeffer, MD, MPH1, M. Chad Wallis, MD1, Patrick C. Cartwright, MD1, Deborah L. Jacobson, MD, MS1.
1University of Utah, Salt Lake City, UT, USA, 2University of Utah, Salt Lake City, UT, USA.
BACKGROUND: The financial implications of care for patients with myelomeningocele is important for many stakeholders, particularly as patients transition from pediatric to adult care providers. This study examines the total cost of care for patients with myelomeningocele, stratified by age, over a 10-year period from 2007-2017. Urology-specific parameters are also examined. We hypothesize that the cost of care is increasing over time and higher in the pediatric (<18 years) or adult years (≥27 years) than in the transitional period (age 18-26 years).
METHODS: A retrospective cohort study of commercially insured patients with myelomeningocele was conducted using data from the MarketScan Database (2007-2017). Patient demographics, care episode type, and cost data were extracted. Overall and urology-specific parameters were examined, and descriptive statistics were performed. The overall and urology-specific cost of care was calculated annually, and age-based cohort comparisons were made.
RESULTS: A total of 56,539 patients with myelomeningocele were identified. Patients were primarily female (63%) and treated in the southern region (40%). Myelomeningocele levels were largely unspecified (95%). On average, 93% were seen as outpatients (mean annual cost of $210 million), 15% ($178 million) were admitted as inpatients, 32% ($87 million) were seen in the emergency department (ED), and 21% ($166 million) underwent a surgical procedure annually. On average 16% ($10 million), 1% ($14 million), 1% ($6 million), and 9% ($8 million) were seen for urology-specific outpatient, inpatient, ED, and surgical visits annually. Between 2008-2017, the annual cost per pediatric patient with myelomeningocele increased in all categories of care observed (Figure 1-4; outpatient [$535 ± 192 increase per patient per year], inpatient [$3,805 ± 3,480], surgical [$1,820 ± 1,867], and ED [$544 ± 944]). The same trends were observed for transitional and adult care. The mean annual cost per patient was highest among pediatric patients in the outpatient (pediatric $9,928, adult $8,410, transition $7,338), inpatient (pediatric $10,200, adult $6,050, transition $6,195), and surgical settings (pediatric $9,743, adult $5,648, transition $5,485). However, the mean annual cost per patient was highest among transitional patients in the ED setting (pediatric $3,711, adult $3,496, transition $3,748).
CONCLUSIONS: The annual cost of care for patients with myelomeningocele increased among all age groups from 2007-2018. While outpatient, inpatient, and surgical care was costliest among pediatric patients, ED care was costliest among transitional patients. It would be beneficial for all stakeholders to identify more cost-effective means to providing necessary care during the transitional period. 
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