Pediatric inpatient hospital resource use for congenital heart defects

Abstract

Background: Congenital heart defects (CHDs) occur in approximately 8 per 1000 live births. Improvements in detection and treatment have increased survival. Few national estimates of the healthcare costs for infants, children and adolescents with CHDs are available.

Methods: We estimated hospital costs for hospitalizations using pediatric (0-20 years) hospital discharge data from the 2009 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) for hospitalizations with CHD diagnoses. Estimates were up-weighted to be nationally representative. Mean costs were compared by demographic factors and presence of critical CHDs (CCHDs).

Results: Up-weighting of the KID generated an estimated 4,461,615 pediatric hospitalizations nationwide, excluding normal newborn births. The 163,980 (3.7%) pediatric hospitalizations with CHDs accounted for approximately $5.6 billion in hospital costs, representing 15.1% of costs for all pediatric hospitalizations in 2009. Approximately 17% of CHD hospitalizations had a CCHD, but it varied by age: approximately 14% of hospitalizations of infants, 30% of hospitalizations of patients aged 1 to 10 years, and 25% of hospitalizations of patients aged 11 to 20 years. Mean costs of CHD hospitalizations were higher in infancy ($36,601) than at older ages and were higher for hospitalizations with a CCHD diagnosis ($52,899). Hospitalizations with CCHDs accounted for 26.7% of all costs for CHD hospitalizations, with hypoplastic left heart syndrome, coarctation of the aorta, and tetralogy of Fallot having the highest total costs.

Conclusion: Hospitalizations for children with CHDs have disproportionately high hospital costs compared with other pediatric hospitalizations, and the 17% of hospitalizations with CCHD diagnoses accounted for 27% of CHD hospital costs.

Keywords: Kids' Inpatient Database; healthcare resource use; heart defects, congenital; hospital costs.

FIGURE 1

Total costs of hospitalizations with critical congenital heart defects as a percentage of total costs of all hospitalizations with any congenital heart defect; total hospitalizations with a critical congenital heart defect as a percentage of total hospitalizations with any congenital heart defect, by age. CHD, congenital heart defect; HLHS, hypo-plastic left heart syndrome; Coarc, coarctation of the aorta; ToF, tetralogy of Fallot; DORV, double outlet right ventricle; TGA, transposition of the great arteries; Single, single ventricle; Pulm Atr, pulmonary atresia; Aortic, interruption or hypoplasia of aortic arch; Tric Atr, tricuspid atresia; TAPVR, total anomalous pulmonary venous return; Truncus, truncus arteriosus; Ebstein, Ebstein anomaly