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Practice patterns and resource utilization for infants with bladder exstrophy: a national perspective
Anthony J Schaeffer1, Emilie K Johnson1, Tanya Logvinenko2
1Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
Insights
The first year cost for bladder exstrophy (BE) care is substantial, averaging $66,577. Early closure within 3 days and avoiding comorbidities reduce costs.
Area of Science:
- Pediatric Urology
- Healthcare Economics
- Congenital Anomalies
Background:
- Bladder exstrophy (BE) care exhibits significant variability.
- Understanding the economic burden of BE is crucial for resource allocation.
Purpose of the Study:
- To define care patterns for bladder exstrophy (BE).
- To determine the first-year cost of BE management in US pediatric hospitals.
Main Methods:
- Utilized the Pediatric Health Information System database (1999-2010).
- Identified patients undergoing primary BE closure within 120 days of life.
- Analyzed demographic, surgical, postoperative, and cost data using multivariate regression.
Main Results:
- 73% of 381 patients had primary closure within 3 days of life.
- First-year median cost was $66,577; non-renal comorbidities and delayed closure (>30 days) increased costs.
- Pelvic osteotomy rates varied by closure timing (18% to 86%).
Conclusions:
- Most bladder exstrophy (BE) closures occur within the first 3 days of life.
- Osteotomy is common for later closures; non-renal comorbidities and longer hospital stays increase costs.
- Early intervention and managing comorbidities are key to optimizing BE care costs.
Purpose:
Substantial variability exists in bladder exstrophy care, and little is known about costs associated with the condition. We define the care patterns and first year cost for patients with bladder exstrophy at select freestanding pediatric hospitals in the United States.
Materials And Methods:
We used the Pediatric Health Information System database to identify patients with bladder exstrophy born between January 1999 and December 2010 who underwent primary closure in the first 120 days of life. Demographic, surgical, postoperative and cost data for all encounters were assessed. Multivariate linear regression was used to examine the association between patient, surgeon and hospital characteristics and costs.
Results:
Of the 381 patients who underwent primary closure within the first 120 days of life 279 (73%) did so within the first 3 days of life. A total of 119 patients (31%) underwent pelvic osteotomy, including 51 of 279 (18%) who underwent closure within the first 3 days of life, 38 of 67 (56%) who underwent closure between 4 and 30 days of life, and 30 of 35 (86%) who underwent closure between 31 and 120 days of life (p = 0.0017). Median inflation adjusted, first year cost in United States dollars per patient was $66,577 (IQR $45,335 to $102,398). Presence of nonrenal comorbidity and completion of primary closure after 30 days of life increased first year costs by 24% and 53%, respectively. Increased post-closure length of stay was associated with greater costs.
Conclusions:
At select freestanding United States pediatric hospitals the majority of bladder exstrophy closures are performed within the first 3 days of life. Most, but not all, patients undergoing closure after the neonatal period undergo osteotomy. The presence of nonrenal comorbidity and increased postoperative length of stay are associated with greater costs.
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