Economic burden of paediatric-onset disabilities among young and middle-aged adults in the USA: a cohort study of privately insured beneficiaries

Abstract

ObjectiveIndividuals with paediatric-onset disabilities (PoDs) have complex healthcare needs and are susceptible to adverse health outcomes, which may impose a higher strain on healthcare resources. The burden of healthcare resource utilisation and costs attributed to the population of adults with PoDs is not clearly established. The objective here was to compare healthcare resource utilisation and costs between adults with versus without PoDs.DesignCohort.SettingData were from the 2016 Optum Clinformatics Data Mart, a de-identified nationwide claims database of beneficiaries from a single private payer in the USA.ParticipantsInternational Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes were used to identify beneficiaries with PoDs that were between 18 and 64 years of age.Primary and secondary outcome measuresAnnual all-cause healthcare resource utilisation and total healthcare costs were compared between adults with and without PoDs before and after adjusting for sociodemographics and several costly non-communicable diseases.ResultsAdults with PoDs (n=121 446) had greater annual mean counts of service utilisation for all service types (eg, inpatient, outpatient, emergency visits) compared with adults without PoDs (n=5 415 475) before and after adjustments (all p<0.001). Adults with PoDs had greater unadjusted total standardised reimbursement costs (US$26 702 vs US$8464; mean difference=US$18 238; cost ratio (CR)=3.16; 95% CI=3.13 to 3.18) and total patient out-of-pocket costs (US$2226 vs US$1157; mean difference=US$1069; CR=1.88; 95%CI=1.86 to 1.89). After adjustments, total standardised reimbursement costs were 2.32 times higher (95% CI=2.30 to 2.34) and total patient out-of-pocket costs were 1.65 times higher (95% CI=1.64 to 1.66) compared with adults without PoDs.ConclusionAdults with PoDs had greater healthcare utilisation and costs, even after accounting for costly diseases. Future research is needed to identify the cost drivers for adults with PoDs.

<p>Incidence Rate of Advanced Chronic Kidney Disease Among Privately Insured Adults with Neurodevelopmental Disabilities</p>

“…This database has been described previously. 22 Briefly, this is a nationwide de-identified single private payer administrative claims database in the United States, which houses insurance-related data from individuals who have Medicare Advantage or commercial health plans. Individuals covered by Medicare may opt to enroll in a private Medicare Advantage health plan in addition to the traditional Medicare program.…”

“…Medicare Advantage health plans may offer additional coverage that is not readily available in the traditional Medicare program. 22 In order to enroll in a private payer health plan, including commercial or Medicare Advantage, individuals of any income, age, or disability status either pay for the insurance coverage or the insurance coverage is paid through their employer. To limit patient identifiers, research teams using the Optum Clinformatics ® Data Mart Database are allowed either the Date of Death or Socioeconomic Status table.…”

The mortality burden of non-trauma fracture for adults with cerebral palsy

“…These claims-based data include all health service utilization (e.g., inpatient, emergency department) for each individual throughout their enrollment. These nationwide databases have been described elsewhere ( Whitney et al, 2019e ; Whitney, 2019a ) including number of beneficiaries covered and eligibility criteria for coverage. Briefly, the Optum Clinformatics® Data Mart Database covers individuals of any income, age, or disability status with commercial or Medicare Advantage health plans.…”

Effectiveness of osteoporosis medication on site‐specific fracture‐risk attenuation among adults with epilepsy

“…Claims data were ascertained from January 1, 2012 to September 30, 2015 from Optum Clinformatics Data Mart Database (OptumInsightTM, Eden Prairie, MN, USA). This national single private payer administrative claims database contains medical and outpatient pharmacy information from privately insured or Medicare Advantage beneficiaries in the United States and has been described previously in detail 16 . Because data are de‐identified, the University Institutional Review Board approved this study as non‐regulated.…”