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Chronic Medication Burden After Cardiac Surgery for Pediatric Medicaid Beneficiaries
Joyce L Woo1, Katherine A Nash2, Kacie Dragan3
1Division of Pediatric Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
Insights
Children with congenital heart defects have a high medication burden throughout childhood. This study highlights the significant medication use and costs in these pediatric patients, informing care for this complex group.
Area of Science:
- Pediatric Cardiology
- Health Services Research
- Pharmacoeconomics
Background:
- Congenital heart defects (CHDs) are the most common and costly birth defects.
- Increasing survival rates for children with CHDs necessitate understanding their long-term health and resource needs.
Purpose of the Study:
- To analyze chronic outpatient prescription medication use and expenditures in New York State pediatric Medicaid enrollees.
- To compare medication patterns between children undergoing cardiac surgery and the general pediatric population.
Main Methods:
- Retrospective cohort study of pediatric Medicaid enrollees (2006-2019).
- Utilized the New York State Congenital Heart Surgery Collaborative for Longitudinal Outcomes and Utilization of Resources database.
- Primary outcomes included chronic medication use (per person-year) and associated expenditures.
Main Results:
- Over 40% of children undergoing cardiac surgery used chronic medications vs. 10% of the general pediatric population.
- Medication expenditures were 10 times higher per person-year for children with CHDs.
- Disease severity correlated with medication use; infants had highest use, but nearly half of adolescents used chronic medications.
Conclusions:
- Children who undergo cardiac surgery face a substantial and persistent medication burden throughout childhood.
- Findings can guide clinicians and policymakers in optimizing care and value for medically complex pediatric populations with CHDs.
Background:
Congenital heart defects are the most common and resource-intensive birth defects. As children with congenital heart defects increasingly survive beyond early childhood, it is imperative to understand longitudinal disease burden.
Objectives:
The purpose of this study was to examine chronic outpatient prescription medication use and expenditures for New York State pediatric Medicaid enrollees, comparing children who undergo cardiac surgery (cardiac enrollees) and the general pediatric population.
Methods:
This was a retrospective cohort study of all Medicaid enrollees age <18 years using the New York State Congenital Heart Surgery Collaborative for Longitudinal Outcomes and Utilization of Resources database (2006-2019). Primary outcomes were total chronic medications per person-year, enrollees per 100 person-years using ≥1 and ≥3 medications, and medication expenditures per person-year. We described and compared outcomes between cardiac enrollees and the general pediatric population. Among cardiac enrollees, multivariable regression examined associations between outcomes and clinical characteristics.
Results:
We included 5,459 unique children (32,131 person-years) who underwent cardiac surgery and 4.5 million children (22 million person-years) who did not. More than 4 in 10 children who underwent cardiac surgery used ≥1 chronic medication compared with approximately 1 in 10 children who did not have cardiac surgery. Medication expenditures were 10 times higher per person-year for cardiac compared with noncardiac enrollees. Among cardiac enrollees, disease severity was associated with chronic medication use; use was highest among infants; however, nearly one-half of adolescents used ≥1 chronic medication.
Conclusions:
Children who undergo cardiac surgery experience high medication burden that persists throughout childhood. Understanding chronic medication use can inform clinicians (both pediatricians and subspecialists) and policymakers, and ultimately the value of care for this medically complex population.
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