Cost Comparison of Prenatal Myelomeningocele Closure Versus Postnatal Closure for Both Mother and Child at 1 year of Life

Abstract

Abstract INTRODUCTION Prenatal myelomeningocele (MMC) closure has been performed in the United States for 2 decades, though economic impact in terms of cost to the hospital when comparing prenatal to postnatal MMC closure is unclear. METHODS A prospective database of patients undergoing prenatal and postnatal MMC closure between 2011 and 2018 with 1 yr follow up was reviewed. Charge data for relevant admissions was converted to a cost estimate using our institution's Medicare hospital-specific cost-to-charge ratio and corrected to the 2018 US dollar. Children, mothers, and mother/child pairs were considered separately. Additional data included length of stay (LOS), gestational age at birth, readmission, and need for ventriculoperitoneal shunt placement. RESULTS Average cost to prenatal MMC closure children was $67,331.49 (median $58,406.71), compared to $89,502.01 (median $49,889.95) for postnatal MMC closure children (P = .28). Cost to prenatal MMC closure mothers was $28,476.12 (median $24,548.29), compared to $5039.27 (median $5,087.30) (P < .001). Cost of care for prenatal MMC closure mother/child pairs was $95,803.11 (median $102,377.75), compared to $94,541.28 (median $55,667.82) (P = .45). Prenatal MMC closure children had shorter gestational age at birth (235.81 d vs 265.77 d, P < .001), fewer readmissions (33.3% vs 72.7%, P < .001), and shunt placement was less common (33.3% vs 90.9%, P < .001). Prenatal MMC closure mothers had longer total LOS (15.92 d vs 4.68 d, P < .001) and more readmissions (18.5% vs 0.0%, P = .06). Total LOS for prenatal MMC closure mother/child pairs was 43.70 d compared to 30.41 d, though not significant (P = .09). CONCLUSION Cost of prenatal versus postnatal MMC closure did not significantly differ from a hospital perspective at 1 yr. When considering the mother alone, prenatal MMC closure was costlier. Future work is needed assessing cost from a patient and societal perspective both at 1 yr and beyond.