Author + information
- Nelangi Marie Pinto,
- Richard Nelson,
- Lorenzo Botto,
- L. LuAnn Minich,
- Sergey Krikov and
- Norman Waitzman
Population costs for critical congenital heart disease (CCHD) based on administrative or claims data are often inaccurate due to limitations in case ascertainment. Linking the Utah Birth Defect Network (UBDN, state surveillance) and Utah Population Database (UPDB, state inpatient discharge and vital records) allows longitudinal tracking independent of ICD-9-DM codes. We linked the UBDN to the UPDB to analyze CCHD costs through age 5 yrs.
CCHD births 1997 to 2011 were verified at the UBDN. Costs were adjusted to 2013 $. Multivariable generalized linear regression determined associated factors with subgroup analyses for hypoplastic left heart syndrome (HLHS) and tetralogy of Fallot (TOF). Mortality was analyzed by multivariable Cox hazard models.
In 1307 CCHD births, mean costs were $97,344 yr 1 and $16,729 yrs 1-5. Compared to HLHS, costs were lower for TOF, but similar for pulmonary atresia and truncus (Table 1). Comorbidities and lower SES increased costs. Prenatal diagnosis predicted increased yr 1 costs in the overall cohort and TOF, but not HLHS or for any model of yrs 1-5 or with deaths excluded. Prenatal diagnosis was not associated with mortality overall or for TOF but decreased risk for HLHS (HR 0.6, p=0.03).
The impact of prenatal diagnosis on costs and outcomes differed by CCHD type warranting further study. Rigorously tracking CCHD cohorts provides valid benchmark cost estimates for further comparative effectiveness analyses of various interventions.
|Multivariate model of factors associated with costs at 1 and 1-5 years (*<$100 difference)|
|Factor||<365 days||1-5 years of age|
|$ Increase (x 103 )||P value||$ Increase (x 103 )||P value|
|CCHD Diagnosis (HLHS ref)|
|Additional birth defect||20.4||0.06||13.0||0.02|
|Gestational age (wk)||−7.7||<0.001||*||0.98|
|Additional complex chronic condition|
|Year of birth||6.9||<0.001||0.3||0.54|
|Maternal non-white race||−14.9||0.07||−4.4||0.30|
< High school (ref)
|Geographic poverty indicator (% below)|
Poster Area, South Hall A1
Monday, April 04, 2016, 9:45 a.m.-10:30 a.m.
Session Title: Utilization, Outcomes, and Quality Improvement in Pediatric Cardiac Care
Abstract Category: 23. Congenital Heart Disease: Pediatric
Presentation Number: 1258-203
- 2016 American College of Cardiology Foundation