Healthcare Burden in Children with Complex Congenital Urologic Anomalies During the First Three Years of Life
Cynthia A. Sharadin, MD, Joshua J. Horns, PhD, Patrick C. Cartwright, MD, Anthony J. Schaeffer, MD.
University of Utah, Salt Lake City, UT, USA.
BACKGROUND: There are few studies determining the healthcare burden of complex congenital urologic anomalies (CCUA) relative to other congenital anomalies. Recognizing resource utilization could help healthcare systems to decrease these burdens. The aim of this study was to determine the 3-year cumulative healthcare burden (defined as financial cost and healthcare encounter days spent) for individuals with CCUA. We hypothesized that 1) those with CCUA will have reduced healthcare burden relative to children born prematurely (CBPre) or with other major congenital anomalies and that 2) children with bladder exstrophy will have the highest healthcare burden among CCUA.
METHODS: We performed a case-control study utilizing the IBM MarketScan database, from years 2011-2020. CCUA included bladder exstrophy-epispadias (BE), posterior urethral valves (PUV), prune belly syndrome (PBS), and vesicoureteral reflux (VUR). Control subjects included CBPre and those with congenital heart disease (CHD), omphalocele/gastroschisis (OG), congenital clubfoot (CC), and a random sample of children from the general population. ICD and CPT codes were used to identify cases and controls. The outcomes were cumulative cost (US$) and cumulative healthcare encounter days during the first 3 years of life. Comparisons between groups (CCUA versus all other comparators) and within the CCUA group were performed, with a Bonferroni-corrected p-value < 0.001 considered significant.
RESULTS: We identified 7599 children with CCUA (47 BE, 206 PUV, 42 PBS, and 7813 VUR). Controls included 2220 with CHD, 1489 with OG, 156 with CC, 57958 with CBPre, and 7267 children from the sample population. In the first 3 years of life, the average cumulative per-patient cost for CCUA was $15.4K [$14.9, 16.1K]. This was higher than the population sample ($5.6K [$5.4K, $5.7K], p<0.001), similar to OG abnormalities ($18.1K [$17.1K, $21.4K], p=0.06), and lower than CBPre ($39.2K [$38.4K, $40.0K], p<0.001), CHD ($188K [$171.1K, $208.2K], p<0.001), and CC ($121.9K [$90.1K, $165.0K], p <0.001). At 3 years, total healthcare days in CCUA (74.1 [70.7, 77.6]) was greater than the population sample (36.4 [35.2, 37.6], p<0.001), similar to OG anomalies (105.6 [84.7, 126.4], p=0.003), and less than those CBPre (118.9 [116.8, 121.0], p<0.001), with CHD (228.6 [211.3, 245.8], p<0.001), or with CC (270.9 [186.9, 354.9], p<0.001). [Figure 1]
Within CCUA, the per-patient cost was highest among children with BE ($146.3K [$92.3-231.8K]) at 3 years. However, the cumulative healthcare days were highest among children with PUV and PBS (183.6 and 178.9 days, respectively). [Figure 2]
CONCLUSIONS: Children with CCUA contribute more to the overall healthcare burden than the general population, but less than those born prematurely, or those with congenital heart/orthopedic conditions. These data will help guide expectations regarding financial cost and time commitments in children with CCUA.
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