OBJECTIVES

To compare healthcare resource utilization (HRU), healthcare charges, and societal costs among infants born prior to 37 weeks gestational age (weeks GA) in a US Medicaid population.

METHODS

Premature infants from 6 state Medicaid databases born 1997─2018 were retrospectively identified using International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification (ICD-9-CM/ICD-10-CM) codes. Cohorts included infants who were extremely premature (EP; ≤28 weeks GA), very premature (VP; ≥29 to <32 weeks GA), and moderate-to-late premature (M-LP; ≥32 to <37 weeks GA). The index hospitalization was the initial neonatal intensive care unit admission. Unadjusted and adjusted generalized linear models were used to compare all-cause and respiratory-related HRU, healthcare charges and societal costs (estimated as work loss hours X hourly wages for one parent, 2018 adjusted USD) between cohorts, from birth to 2 years corrected age (CA) or death.

RESULTS

Of 25,573 infants included in the analysis, 17.4% (n=4,462) were EP, 11.4% (n=2,904) were VP, and 71.2% (n=18,207) were M-LP. Average index hospitalization length of stay increased with decreasing GA; 20.0 days M-LP, 48.8 days VP, 83.2 days EP. The rate of all-cause (and respiratory-related) re-hospitalizations [24.9% (16.7%) M-LP; 33.9% (24.2%) VP; 44.8% (35.1%) EP], emergency department visits [70.8% (48.7%) M-LP; 73.3% (53.9%) VP; 76.0% (57.2%) EP], and outpatient visits [86.7% (57.3%) M-LP; 93.8% (68.5%) VP; 94.3% (73.7%) EP], also increased with decreasing GA. Excluding the index hospitalization, the financial burden was highest for EP infants [estimated at $74,436 for total healthcare charges ($39,231 respiratory-related) and $28,504 for total societal costs ($7,528 respiratory-related)].

CONCLUSIONS

From birth to 2 years CA, HRU, healthcare charges and societal costs increased with decreasing GA and were highest for EP infants. Respiratory illness contributed significantly to this burden. Strategies to improve clinical outcomes for EP infants may reduce the preterm birth burden on healthcare systems and families.