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The Age-stratified Cost of Biliary Atresia: A MarketScan®-Based Cost Analysis
Anastasia M Kahan1, Anna Gongjoo Holley1, Joshua Horns1
1University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, USA.
Insights
Early diagnosis and intervention for biliary atresia (BA) significantly reduce healthcare costs. Performing Kasai portoenterostomy (KP) before 60 days of age is associated with lower expenditures compared to later intervention or liver transplant.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Health Economics
Background:
- Biliary atresia (BA) is a primary cause of pediatric liver failure, necessitating liver transplantation.
- Early diagnosis and Kasai portoenterostomy (KP) are crucial for preventing liver failure and transplant in affected children.
Purpose of the Study:
- To evaluate the healthcare costs associated with biliary atresia (BA) in the United States.
- To test the hypothesis that earlier Kasai portoenterostomy (KP) leads to lower healthcare costs.
Main Methods:
- A retrospective cohort study analyzed healthcare costs for BA patients using the MarketScan® database.
- Costs were stratified by age at KP (early <60 days vs. late ≥60 days) and transplant status, with analyses at 1, 3, and 5-year intervals.
- Statistical analyses included ANOVA and Gaussian multivariate methods.
Main Results:
- 170 children with BA were identified; 86 had early KP, 78 had late KP, and 6 underwent primary transplant.
- Predicted 3-year costs were $283,035 for early KP (no transplant), $738,958 for late KP (no transplant), and $1,015,806 for transplant recipients.
- Insurance discontinuity was observed in nearly 90% of patients within five years.
Conclusions:
- Healthcare costs for BA patients are substantial and directly influenced by the age of intervention.
- Early diagnosis and timely Kasai portoenterostomy (KP) are vital for improving patient outcomes and reducing overall healthcare expenditures.
- Addressing insurance discontinuity is important for long-term patient management.
Introduction:
Biliary atresia (BA) is the leading cause of childhood liver failure requiring liver transplantation. Early diagnosis and Kasai portoenterostomy (KP) offer the only opportunity to avoid liver failure and transplantation. This study aimed to assess BA healthcare costs in the United States. We hypothesized that patients who underwent KP before 60 days of age would incur lower healthcare costs than patients who underwent KP at 60 days or older.
Methods:
Using MarketScan® (Truven Health Analytics), we evaluated cumulative healthcare costs for BA patients who had KP at less than 60 days (early KP), at 60 days or older (late KP), or had liver transplant - primarily or following KP. Cumulative costs were calculated at one-, three-, and five-year intervals, stratified by age at KP and transplant status. ANOVA univariate and Gaussian multivariate analyses were performed.
Results:
170 children with BA were identified: 86 underwent early KP (50.6 %), 78 underwent late KP (45.9 %), and six were primarily transplanted (3.5 %). 101 patients (59.4 %) were enrolled in their insurance plan at one year, 45 (26.4 %) at three years, and 23 (13.5 %) at five years. Predicted total costs at three years were $283,035 for early KP (no transplant), $738,958 for late KP (no transplant), and $1,015,806 for patients requiring transplant regardless of KP status.
Conclusion:
The average healthcare costs for BA patients are significant and depend upon age at intervention. Nearly 90 % of children experience insurance discontinuity within five years of diagnosis. Early BA diagnosis is integral to optimizing outcomes and minimizing healthcare expenditures.
Type Of Study:
Retrospective cohort study.
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