<p>Characteristics and health care utilization of otherwise healthy commercially and Medicaid-insured preterm and full-term infants in the US</p>

Abstract

Purpose This study examined health care utilization and costs during the first year of life for preterm and full-term infants in the US. Subjects and methods Preterm (<37 weeks gestational age [GA]) and full-term infants born 2003 to 2012 without complex medical conditions were identified in the MarketScan ® Commercial and Multi-State Medicaid claims databases using ICD-9-CM diagnosis and diagnosis-related grouping codes. Inpatient and outpatient claims from birth through the first year were analyzed for preterm and full-term subgroups. Results were stratified by payer. Results There were 1,692,935 commercially insured infants (12.5% preterm) and 1,873,324 Medicaid-insured infants (13.9% preterm). The majority (>75%) of preterm infants were admitted to the neonatal intensive care unit during their birth hospitalization. Generally, mean length of stay and costs for birth hospitalizations increased with decreasing GA. The average cost of a birth hospitalization was US $62,931 (SD $134,347) for commercially insured preterm infants and $43,858 (SD $115,412) for Medicaid-insured preterm infants compared to $2,401 (SD $7,399) and $1,894 (SD $5,444) for commercially insured and Medicaid-insured full-term infants, respectively. Post-neonatal hospitalization rates increased as GA decreased (in full-term to <29 weeks GA: commercial =3.3%–19.5%; Medicaid =6.1%–26.2%). Preterm infants had greater average numbers of outpatient office visits and pharmacy claims than full-term infants. Following birth discharge, mean monthly health care costs per infant increased as GA decreased (commercial = $334 to $3,126; Medicaid = $205 to $2,473). Conclusion During the first year of life, post-neonatal hospitalization rates, outpatient office visits, pharmacy claims, and monthly costs increased as GA decreased.

Socioeconomic Impact of RSV Hospitalization

“…In addition, preterm infants require increased hospitalization length of stay, number of outpatient visits, pharmacy claims, and mean monthly health care costs (Fig. 2 ) compared to term infants [ 34 ].

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Fig. 2 Mean monthly health care cost per infant increases as the gestational age decreases [ 34 ]. FT full-term, US$ United States dollars, wGA weeks’ gestational age.

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Risk of RSV-related hospitalization is associated with gestational age in preterm (born at 29–34 wGA) infants without outpatient palivizumab administration

“…These results are consistent with prior studies that have shown higher levels of all-cause resource use in the first year of life when comparing Medicaid-insured and commercially insured infants. 25 Additional research is necessary to determine whether differences in RSV-related healthcare resource use and RSVH severity in Medicaid-insured and commercially insured infants can be explained by baseline differences in the two populations or if additional factors contribute to disparities in RSV outcomes.…”

“…All analyses were conducted separately in Medicaid-insured and commercially insured infants due to underlying differences in the rate of hospitalization and healthcare resource use in the first year of life that have been previously described. 25 Descriptive analyses of baseline characteristics, including infant demographic, clinical, and birth hospitalization characteristics were conducted in term infants as well as in each subgroup of preterm infants. Chi-square or Fisher’s exact tests for nominal/categorical variables and t-tests for interval/continuous variables were used to compare patient characteristics in each subgroup of preterm infants to term infants.…”

The Utilization of Early Outpatient Care for Infants Following NICU Discharge among a National Sample

“…The evidence that exists on outpatient services and prescription drug use shows that preterm neonates are high utilizers of these services [9][10][11][12][13][14]. Previous work, however, lacks important descriptors of outpatient followup immediately following NICU discharge, instead exploring service use months to years later [15]. This work also focuses on the smallest, most premature babies, who represent a high-risk, albeit small, proportion of infants in most NICUs.…”