Objective

To identify cumulative 5-year healthcare costs and healthcare days in children with anorectal malformation (ARM) and to compare the cumulative 5-year healthcare costs and healthcare days in children with ARM with 3 control cohorts: healthy, premature, and congenital heart disease (CHD).

Study design

We performed a retrospective case–control study using the Truven MarketScan database of commercial claims encounters between 2008 and 2017. The ARM, CHD, and premature cohorts were identified using a targeted list of International Classification of Diseases 9th or 10th Revision diagnosis and Current Procedural Terminology codes. The healthy cohort included patients without ARM, preterm birth, or CHD.

Results

We identified 664 children with ARM, 3356 children with heart disease, 63 190 children who were born preterm, and 2947 healthy patients. At 5 years, the total healthcare costs of children with ARM ($273K, 95% CI $168K-$378K) were similar to the premature cohort ($246K, 95% CI $237K-$255K) and lower than the CHD cohort ($466K, 95% CI $401K-$530K, P < .001). Total healthcare days were similar in children with ARM (158 days, 95% CI 117-198) and prematurity (141 days, 95% CI 137-144) but lower than CHD (223 days, 95% CI 197-250, P = .02). In ARM, outpatient care (126 days, 95% CI 93-159) represented the largest contribution to total healthcare days.

Conclusions

Children with ARM accumulate similar healthcare costs to children with prematurity and comparable healthcare days to children with CHD and prematurity in the first 5 years of life. Outpatient care represents the majority of healthcare days in children with ARM, identifying this as a target for quality improvement and demonstrating the long-term impact of this condition.

中文翻译：

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肛门直肠畸形儿童 5 岁以内的医疗保健负担和费用

客观的

确定肛门直肠畸形 (ARM) 儿童的累积 5 年医疗费用和医疗天数，并比较 ARM 儿童与 3 个对照组：健康、早产和先天性心脏病的累积 5 年医疗费用和医疗天数。冠心病）。

学习规划

我们使用 Truven MarketScan 数据库对 2008 年至 2017 年间的商业索赔进行了回顾性病例对照研究。使用国际疾病分类第 9或第 10 修订版诊断和当前程序术语的目标列表确定了 ARM、CHD 和早产队列代码。健康队列包括没有 ARM、早产或 CHD 的患者。

结果

我们确定了 664 名 ARM 儿童、3356 名心脏病儿童、63190 名早产儿童和 2947 名健康患者。5 年时，ARM 患儿的总医疗保健费用（$273K，95% CI $168K-$378K）与早产队列相似（$246K，95% CI $237K-$255K），低于 CHD 队列($466K, 95% CI $401K-$530K, P  < .001)。ARM（158 天，95% CI 117-198）和早产儿（141 天，95% CI 137-144）的总医疗天数相似，但低于 CHD（223 天，95% CI 197-250，P  = .02)。在 ARM 中，门诊护理（126 天，95% CI 93-159）对总医疗保健天数的贡献最大。

结论

患有 ARM 的儿童在生命的前 5 年内累积的医疗费用与早产儿相似，而医疗日数与患有 CHD 和早产儿的儿童相似。门诊护理代表了 ARM 儿童的大部分医疗保健日，将其确定为质量改进的目标，并展示了这种情况的长期影响。