Out-of-pocket Costs and Total Payments for Common Congenital Hand Difference Procedures

Area of Science:

• Pediatric Surgery
• Health Economics
• Congenital Hand Differences

Background:

• Rising healthcare costs place a significant financial burden on patients and families in the U.S.
• Families of children with congenital hand differences (CHDs) undergoing surgery are particularly vulnerable to these costs.
• Limited data on surgical costs for CHDs hinder efforts to address healthcare inequities.

Purpose of the Study:

• To analyze the financial burden of congenital hand difference surgery in children.
• To identify cost variations based on procedure type, insurance, region, and surgical setting.
• To inform policy recommendations for mitigating costs and ensuring equitable access to care.

Main Methods:

• Utilized the MarketScan Commercial Claims database (2016-2022) for children aged 5 and under undergoing CHD surgery.
• Collected data on total and out-of-pocket payments, adjusting all costs to 2022 dollars.
• Employed linear regression to analyze cost trends and disparities.

Main Results:

• Analyzed 3070 cases; trigger thumb release and syndactyly repair were most common.
• Median total payment was $3763, with median out-of-pocket costs at $544.
• Pollicization procedures had the highest median total payment ($11,882); constriction ring syndrome had the lowest ($2080).
• High-deductible health plans, Northeast region, and hospital settings were associated with higher total costs.

Conclusions:

• Children undergoing CHD surgery face considerable financial burdens, with costs varying significantly.
• Cost disparities exist based on procedure, region, insurance type, and provider specialty.
• Policy interventions are needed to reduce out-of-pocket expenses and address systemic cost variations for equitable care access.