Employer-Sponsored Plan Expenditures for Infants Born Preterm - 2017
Pediatrics October 2017, VOLUME 140 / ISSUE 4 https://doi.org/10.1542/peds.2017-1078
Scott D. Grosse, Norman J. Waitzman, Ninee Yang, Karon Abe, Wanda D. Barfield
- A preterm birth (< 37 weeks) occurs in 1 of 11 of all US births
- Cost to an employer of a preterm infant in the first year is $47,100 more than non-preterm
- These costs do not include maternal costs before nor after the birth
- These costs are an underestimate as premies with Respiratory Distress Syndrome were not included (billing codes did not allow for determination of premies)
Premies have more major Birth Defects
| Percentage | Cost | |
| Preterm | 6.5 % | $ 227,000 |
| Normal | 2.3 % | $ 64,000 |
| Ratio | 2.8 X | 3.5 X |
BACKGROUND: Care for infants born preterm or with major birth defects is costly. Specific estimates of financial burden for different payers are lacking, in part because use of administrative data to identify preterm infants and costs is challenging.
METHODS: We used private health insurance claims data and billing codes to identify live births during 2013 and calculated first-year expenditures for employer-sponsored health plans for infants born preterm, both overall and stratified by major birth defects.
RESULTS: We conservatively estimated that 7.7% of insured infants born preterm accounted for 37% of $2.0 billion spent by participating plans on the care of infants born during 2013. With a mean difference in plan expenditures of ∼$47,100 per infant, preterm births cost the included plans an extra $600 million during the first year of life. Extrapolating to the national level, we projected aggregate employer-sponsored plan expenditures of $6 billion for infants born preterm during 2013. Infants with major birth defects accounted for 5.8% of preterm births but 24.5% of expenditures during infancy. By using an alternative algorithm to identify preterm infants, it was revealed that incremental expenditures were higher: $ 78,000 per preterm infant and $14 billion nationally.
CONCLUSION Preterm births (especially in conjunction with major birth defects) represent a substantial burden on payers, and efforts to mitigate this burden are needed. In addition, researchers need to conduct studies using linked vital records, birth defects surveillance, and administrative data to accurately and longitudinally assess per-infant costs attributable to preterm birth and the interaction of preterm birth with major birth defects.
Cited by 57 studies as of Dec 2023 - including update by authors
- Preterm birth lifetime costs in the United States in 2016: An update PDF
Estimates of healthcare spending for preterm and low-birthweight infants in a commercially insured population: 2008–2016 - Feb 2020
Journal of Perinatology volume 40, pages1091–1099 (2020)
Andrew L. Beam, Inbar Fried, Nathan Palmer, Denis Agniel, Gabriel Brat, Kathe Fox, Isaac Kohane, Anna Sinaiko, John A. F. Zupancic & Joanne Armstrong
Only includes the first 6 month costs. Ignores additional costs for the rest of the life
The growth in healthcare spending is an important topic in the United States, and preterm and low-birthweight infants have some of the highest healthcare expenditures of any patient population. We performed a retrospective cohort study of spending in this population using a large, national claims database of commercially insured individuals. A total of 763,566 infants with insurance coverage through Aetna, Inc. for the first 6 months of post-natal life were included, and received approximately $8.4 billion (2016 USD) in healthcare services. Infants with billing codes indicating preterm status (<37 weeks, n = 50,511) incurred medical expenditures of $76,153 on average, while low-birthweight status (<2500 g) was associated with average spending of $114,437. Infants born at 24 weeks gestation (n = 418) had the highest per infant average expenditures of $603,778. Understanding the drivers of variation in costs within gestational age and birthweight bands is an important target for future studies.
Download the PDF from VitaminDWiki
See also VitaminDWiki
- Preterm births are VERY costly – Feb 2017 assumes $50,000 extra for preterm
probably includes costs of Respiratory Distress for Premies, which were excluded by the study on this page - Preterm 139+ items as of Dec 2023