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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
Employer-Sponsored Plan Expenditures for Infants Born Preterm
Scott D Grosse1, Norman J Waitzman2, Ninee Yang3
1National Center on Birth Defects and Developmental Disabilities, sgrosse@cdc.gov.
Insights
Preterm births, especially with birth defects, significantly increase healthcare costs for payers. More research is needed to accurately track these costs and inform mitigation strategies.
Area of Science:
- Healthcare Economics
- Neonatal Care
- Public Health
Background:
- Infant care for preterm births and major birth defects is expensive.
- Estimating the financial burden on different payers is difficult due to challenges in using administrative data.
Purpose of the Study:
- To estimate the first-year healthcare expenditures for infants born preterm.
- To analyze the impact of major birth defects on the costs associated with preterm births.
Main Methods:
- Utilized private health insurance claims data and billing codes from 2013.
- Identified live births and calculated first-year expenditures for employer-sponsored health plans.
- Stratified costs by preterm births overall and those with major birth defects.
Main Results:
- Preterm infants (7.7%) accounted for 37% of $2.0 billion in infant care costs.
- Preterm births added an estimated $600 million in first-year costs to participating plans.
- Infants with major birth defects represented 5.8% of preterm births but 24.5% of expenditures.
- Alternative algorithms indicated higher incremental costs ($78,000 per infant, $14 billion nationally).
Conclusions:
- Preterm births, particularly with major birth defects, impose a substantial financial burden on payers.
- Mitigation strategies are necessary to address the high costs of preterm infant care.
- Linked data studies are crucial for accurate, longitudinal cost assessments of preterm birth and associated birth defects.
Background:
Care for infants born preterm or with major birth defects is costly. Specific estimates of financial burden for different payers are lacking, in part because use of administrative data to identify preterm infants and costs is challenging.
Methods:
We used private health insurance claims data and billing codes to identify live births during 2013 and calculated first-year expenditures for employer-sponsored health plans for infants born preterm, both overall and stratified by major birth defects.
Results:
We conservatively estimated that 7.7% of insured infants born preterm accounted for 37% of $2.0 billion spent by participating plans on the care of infants born during 2013. With a mean difference in plan expenditures of ∼$47 100 per infant, preterm births cost the included plans an extra $600 million during the first year of life. Extrapolating to the national level, we projected aggregate employer-sponsored plan expenditures of $6 billion for infants born preterm during 2013. Infants with major birth defects accounted for 5.8% of preterm births but 24.5% of expenditures during infancy. By using an alternative algorithm to identify preterm infants, it was revealed that incremental expenditures were higher: $78 000 per preterm infant and $14 billion nationally.
Conclusion:
Preterm births (especially in conjunction with major birth defects) represent a substantial burden on payers, and efforts to mitigate this burden are needed. In addition, researchers need to conduct studies using linked vital records, birth defects surveillance, and administrative data to accurately and longitudinally assess per-infant costs attributable to preterm birth and the interaction of preterm birth with major birth defects.
