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A risk-adjusted study of outcome and resource utilization for congenital diaphragmatic hernia
Jasmine C Lam1, Jennifer Claydon, Craig R Mitton
1Division of Pediatric Surgery, Department of Surgery, University of British Columbia, BC Children's Hospital, Vancouver, Canada BC V6H 3V4.
Insights
Infants with congenital diaphragmatic hernia (CDH) incur significantly higher healthcare costs than healthy newborns. The severity of illness, measured by the Score for Neonatal Acute Physiology-version II (SNAP-II), directly correlates with these costs.
Area of Science:
- Neonatal care
- Pediatric surgery
- Healthcare economics
Background:
- Perinatal care for congenital diaphragmatic hernia (CDH) lacks standardization and is resource-intensive.
- Understanding cost drivers and resource utilization in CDH is crucial for optimizing care.
Purpose of the Study:
- To assess if the cost of birth admission for CDH survivors is proportional to illness severity.
- To compare the healthcare costs of CDH survivors with a matched cohort of non-CDH infants.
Main Methods:
- Retrospective review of CDH patient data from British Columbia Children's Hospital (1999-2003).
- Risk stratification of CDH infants using the Score for Neonatal Acute Physiology-version II (SNAP-II).
- Comparison of hospital costs between CDH survivors and a matched non-CDH cohort.
Main Results:
- Twenty-three of 32 CDH infants (72%) survived, with an average length of stay of 46 days.
- Average cost per CDH survivor was $54,102, significantly higher than the $13,722 for the non-CDH cohort (P < .05).
- A significant cost difference was observed among low-, moderate-, and high-risk CDH survivor groups based on SNAP-II scores.
Conclusions:
- Infants with CDH require substantial healthcare resources, with costs escalating with illness severity.
- The SNAP-II score effectively correlates with the total cost of care for CDH patients.
- Further research on larger CDH cohorts can identify cost-effective treatment strategies.
Purpose:
Perinatal care of infants with congenital diaphragmatic hernia (CDH) is nonstandardized and costly. We examined a risk-adjusted cohort of patients with CDH and hypothesized that (1) among CDH survivors, the cost of the birth admission would be proportional to illness severity, and (2) this cost would be significantly higher compared with a matched non-CDH cohort.
Methods:
A retrospective review of costs and outcomes for all patients with CDH admitted to British Columbia Children's Hospital between 1999 and 2003 was performed. Risk grouping of patients with CDH using a validated admission severity score (Score for Neonatal Acute Physiology-version II [SNAP-II]) was conducted, enabling comparison among infants surviving to discharge. Hospital costs were also compared with a contemporaneous, non-CDH cohort matched for birth weight and SNAP-II.
Results:
Thirty-two infants with CDH were included, of who 5 required extracorporeal membrane oxygenation. Twenty-three (72%) infants survived to discharge, with an average length of stay of 46 days. Average cost per survivor to discharge was 54,102 dollars (vs 13,722 dollars for the non-CDH cohort; P < .05). After SNAP-II stratification of survivors into low-, moderate-, and high-risk groups, a significant cost difference was noted between the moderate- and low-risk and high- and low-risk groups, respectively.
Conclusions:
Infants born with CDH require costly care and can be expected to consume disproportionate resources. Admission SNAP-II score correlates with total cost to discharge. Risk stratification and cost comparison of larger CDH populations may allow identification of cost-efficient treatment strategies.