Employer-Sponsored Plan Expenditures for Infants Born Preterm

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.