Key Findings: Hospital Use, Associated Costs, and Payer Status for Infants Born with Spina Bifida

A special issue of the journal Birth Defects Research (Part A) has recently released a new study online: “Hospital Use, Associated Costs, and Payer Status for Infants Born with Spina Bifida.” You can read the article’s abstract here. See below for a summary of the findings from this article.

Main findings from this study:

About 18% of babies with spina bifida had more than three hospital stays initiated in their first year of life. The presence of other birth defects seemed to influence the length of stay in the hospital and hospital costs. Infants who had private insurance only or who had a mix of public and private insurance had fewer hospital stays. Further research should focus on what factors might lead to longer hospital stays or higher costs.

• Median number of hospital stays per infant with spina bifida: 2 (range: 1-12 stays)
• Median number of total days in the hospital (for hospital stays initiated in the first year of life): 14 (range: 0-476 days)
• Median hospital costs per infant with spina bifida (for hospital stays initiated in the first year of life): $21,937 (range: $96-$1,350,690)

About this study:

What is spina bifida?
Spina bifida is a condition that affects the spine and is present at birth. It is a type of neural tube defect. The neural tube is a structure in an embryo that develops into the brain and spinal cord. Spina bifida happens when the neural tube does not form properly anywhere along the spine. The backbone that protects the spinal cord also does not form properly, resulting in damage to the spinal cord and nerves. Spina bifida might cause physical and mental disabilities that range from mild to severe. The severity depends on

• The size and location of the opening in the spine.
• Whether part of the spinal cord and nerves are affected.
• Whether spinal fluid backs up into the brain (hydrocephalus).

Each year, about 1,500 babies are born with spina bifida in the United States^[1].

What were the results of this study?
This study was a state-wide, population-based analysis of infants with spina bifida. Population-based means that the researchers look at the hospital records of all babies born with spina bifida who live in a defined study area. This type of study is important to get a complete picture of what is happening within this population. All infants in this study were born in Florida between 1998 and 2007. Infants were identified by the Florida Birth Defects Registry and linked to hospital discharge records.

• The study reported that hospital costs for infants with spina bifida were higher for those with only public or those with a combination of private and public insurance compared with costs for those with only private insurance during infancy. But, more research on this topic is needed.
• Also, there were differences in the length of stay between those infants who had public insurance only versus those infants with private insurance only. The longer hospital stays might indicate a worse health status among infants with public insurance. These differences might be due to infants with greater health needs switching from private to public health insurance.
• Compared to all live-born infants in Florida born during the study period, children with spina bifida were more likely to be born low birth weight or preterm. This is similar to findings from previous studies ^[2,3,4].

What does this study add?
Unlike previous studies, this study looked at costs related to both public and private insurance. In addition, this study looked at type of insurance by length of hospital stay, estimated hospital costs, and number of hospital stays initiated in the first year of life per hospital admission and per child. This is unique information that has not been previously studied.

Information from this study may be important to health services researchers as they look at access to care for infants with spina bifida and other birth defects. A better understanding of the patterns of hospital use and costs associated with spina bifida and other birth defects may be useful in program planning and policy development. Ultimately, this could contribute to improved health care delivery, quality of care, and improved health outcomes for infants born with these conditions and their families.

Health Services Related to Birth Defects: CDC’s Activities

CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) is committed to learning more about health service use and costs associated with birth defects:

• CDC currently works with state tracking programs to identify which states have health service use data. This will help us examine many topics, including costs, hospital resource use, access and referral to services, and health outcomes beyond infancy.
• CDC collaborates with several different state tracking systems to research costs associated with birth defects. Researchers are looking at data from different sources in order to get a more complete picture of what the actual costs are related to birth defects.

References

1. Parker SE, Mai CT, Canfield MA, et al. Updated National Prevalence Estimates for Selected Birth Defects in the United States, 2004-2006. Birth Defects Res Part A. 2010;88:1008-16.
2. Honein MA, Kirby RS, Meyer RE, et al. The association between major birth defects and preterm birth. Matern Child Health J. 2009;13:164-175.
3. Petrini J, Damus K, Russell R, et al. Contribution of birth defects to infant mortality in the United States. Teratology 66 Suppl. 2002;1:S3-S6.
4. Purisch SE, DeFranco EA, Muglia LJ, et al. Preterm birth in pregnancies complicated by major congenital malformations: a population-based study. Am J Obstet Gynecol. 2008;199:287.e1-e8.

Key Findings Reference

Radcliff E, Cassell CH, Tanner JP, et al. Hospital use, associated costs, and payer status for infants born with spina bifida. Birth Defects Res A Clin Mol Teratol. 2012 [epub ahead of print].