Overall Hospital Cost Estimates in Children with Congenital Heart Disease: Analysis of the 2012 Kid’s Inpatient Database

Abstract

This study sought to determine overall hospital cost in children with congenital heart disease (CHD) and to compare cost associated with cardiac surgical procedures, cardiac catheterizations, non-cardiac surgical procedures, and medical admissions. The 2012 Healthcare Cost and Utilization Project Kid's Inpatient Database was used to evaluate hospital cost in neonates and children with CHD undergoing cardiac surgery, cardiac catheterization, non-cardiac surgical procedures, and medical treatments. Multivariable logistic regression was applied to determine independent predictors for increased hospital cost. In 2012, total hospital cost was 28,900 M$, while hospital cost in children with CHD represented 23% of this total and accounted for only 4.4% of hospital discharges. The median cost was $51,302 ($32,088-$100,058) in children who underwent cardiac surgery, $21,920 ($13,068-$51,609) in children who underwent cardiac catheterization, $4134 ($1771-$10,253) in children who underwent non-cardiac surgery, and $23,062 ($5529-$71,887) in children admitted for medical treatments. Independent predictors for increased cost were hospital bed size <400 beds (P < 0.001), more than four procedures performed during the same hospitalization (P = 0.001), use of ECMO (P < 0.001), length of hospital stay exceeding 14 days (P < 0.001), cardiac failure (P < 0.001), sepsis (P < 0.001), acute kidney injury (P < 0.001), and neurologic (P < 0.001) and thromboembolic complications (P < 0.001). Hospital cost in children with CHD represented 23% of global cost while accounting for only 4.4% of discharges. This study identified factors associated with increased cost of cardiac surgical procedures, cardiac catheterizations, non-cardiac surgical procedures, and medical management in children with CHD.

Financial burdens and mental health needs in families of children with congenital heart disease

“…High relative treatment costs may contribute to the high prevalence of financial burdens. In the 2012 Kids' Inpatient Database, CHD accounted for 23.3% of global hospital costs, but only 4.4% of hospital discharges, and in the 2013 National Inpatient Sample, CHD accounted for the highest percentage of birth defect–associated hospitalizations . In the current analysis, almost half of CSHCN with CHD had both physical and developmental comorbidities, which may also contribute to high relative financial burdens.…”

“…Financial problems were defined as the parent or caregiver responding "yes" to the question: "Do you have any financial problems due to the child's condition?" Employment impact was defined as the parent or caregiver answering "yes" to (1) cutting down on hours, and/or (2) stopping work due to the child's condition. Caregiver hours was defined as the amount of time a parent or caregiver reported providing in-home care or care coordination for the child (<1, 1-4, 5-10, 11 hours/week, and dichotomized as < or 11 hours/week).…”

“…Treatment costs can be high as a significant proportion of children with CHD require one or more surgeries. According to the 2012 Kids' Inpatient Database, total hospital costs including both cardiac and noncardiac procedures and medical treatment exceeded 6 billion dollars for children with CHD . Additionally, many children with CHD have one or more comorbidities, such as developmental delay or other congenital anomalies that contribute to the complexity and cost of care .…”

Resource and cost considerations in treating hypoplastic left heart syndrome

“…ECMO support, which can occasionally be needed after a Norwood I operation, and almost never so after more common repairs of low-risk diagnoses, is also associated with increased resource utilization. 34 …”

Assessing the Risks of Noncardiac Surgery for Children With Congenital Heart Disease∗

“…Second, the ACS NSQIP classification of "major" CHD is clinically quite broad and heterogeneous. These are important limitations in light of findings by Faraoni et al (5) as well as a recent publication from the ACS(16). The ACS and its Task Force for Children's Surgical Care have called for a system to designate pediatric surgical centers as "basic, advanced, and comprehensive," according to resources (17).…”