Estimated Cost-Effectiveness of Intensive Interdisciplinary Behavioral Treatment for Increasing Oral Intake in Children With Feeding Difficulties

Abstract

OBJECTIVE : To examine the cost-effectiveness of intensive interdisciplinary behavioral treatment (IIBT) to address severe pediatric feeding difficulties and lead to the removal or prevention of gastrostomy tubes (G tubes) from the perspective of the insurance company. METHODS : Costs associated with G tubes and IIBT were compiled from the available literature and national databases. Costs were updated to price at the start of 2015 to allow data from different years to be analyzed on the same scale. RESULTS : One-way sensitivity and two-way threshold analyses demonstrated that IIBT may be a cost-effective treatment for prevention and removal of G tubes over 5 and 10 years. DISCUSSION : Data from this study can be used to justify cost of services for IIBT, and programs can use these data to discuss conservative savings of IIBT based on their treatment model and level of effectiveness.

An Economic Analysis of Intensive Multidisciplinary Interventions for Treating Medicaid-Insured Children with Pediatric Feeding Disorders

“…For Medicaid-insured children, the G-tube-related expenditure was much lower than specified in previous studies for all states except Rhode Island. 20 However, the difference in expenditure between PFDs with and without G-tube was $47,616 on average per child per year but as high as $82,824 in Minnesota, for example. While the average difference in expenditure is comparable to the cost of G-tube-related care used in previous studies, it reflects all care, not only G-tube-related care.…”

“…A finite-horizon Markov model was employed to sample individual-level health care paths under the 2 treatment arms, IMI with G-tube weaning and G-tube only. 13,20 We assumed similar condition complexities of the children sampled in the 2 arms. A health care path constitutes a sequence of health care states of a virtual PFD-diagnosed child population, assuming that the health care states change every 2 months over a decision horizon, where the health care states are as follows:…”

“…19 Cost of treatment and lack of third-party coverage present important barriers to expanding the availability of this model of care. 19–21 When coverage for IMI is recognized by insurance, coding/billing by third-party payors involves the use of unlisted codes (e.g., Current Procedural Terminology [ CPT ] code 99199—unlisted special services, procedure or report); see Cigna Medical Coverage Policy on Pediatric Intensive Feeding Program, for example. 22 Further, guidelines for Medicaid do not currently include a procedural code for IMI; however, a handful of states (e.g., Michigan; Nebraska) have instituted amendments in Medicaid policy to provide coverage for IMI.…”

“…A recent study evaluating the economic benefits of IMI for children with PFDs used data on health care costs for G-tube treatment and IMI drawn from existing literature and US population surveys. 20 The study focused on the economic benefits from the perspective of commercial insurance. Based on these data, the authors calculated the expenditure differential of IMI v. no IMI (i.e., cost of G-tube placement + maintenance) using decision trees to allow direct comparisons of the costs while aggregating data describing the cumulative effect of intervention and interactivity.…”

Improvements in Children’s Feeding Behavior after Intensive Interdisciplinary Behavioral Treatment: Comparisons by Developmental and Medical Status

“…Behavioral intervention has been found effective for reducing children’s dependency on supplemental tube feedings, increasing calories or grams of foods they consumed orally, expanding diet variety, and improving children’s mealtime disruptive behavior and its associated caregiver stress as well as aversion to mealtimes. Furthermore, research has supported the cost-effectiveness of intensive interdisciplinary behavioral treatment (IIBT) approaches for treating severe feeding problems (Dempster, Burdo-Hartman, Halpin, & Williams, 2016; Williams, Riegel, Gibbons, & Field, 2007).…”