HEALTHCARE RESOURCE UTILIZATION AMONG CHILDREN WITH CONGENITAL HEART DISEASE: A POPULATION-BASED STUDY

Abstract

Data regarding healthcare resource utilization (HRU) in early childhood among children with congenital heart disease (CHD) are scarce. Therefore, we sought to describe the extent of HRU incurred among children with CHD in the first five years of life and examine the extent to which it is modulated by the severity of the disease. In this population-based retrospective cohort study, all children born alive between January 2005-March 2014 in Alberta, Canada were included and followed from birth until five years of age. We linked inpatient, outpatient, practitioner claims, and drug dispensing databases with vital statistics (birth and death registries). Children were grouped by CHD severity level as follows: single ventricle (SV), moderate-complex, simple, and non-CHD. Primary outcomes were the number and rate of health service encounters. HRU rate was compared across CHD groups using a univariate Poisson regression model. Among 448,527 children, 223 (0.1%) children had SV lesions, 2,094 (0.5%) had moderate-complex CHD, and 4,690 (1.1%) simple CHD. In the first year of life, the cumulative hospitalization rate/100 children was 335 (95% CI: 312-360) for SV children, 200 (194-206) for moderate-complex CHD, 152 (149-156) for simple CHD vs. 109 (108-109) among non-CHD children (p<0.001). The ambulatory-care visit rate/100 children was 4,871 (4,780-4,963) for SV, 2,278 (2,258-2,299) for moderate-complex, 1,416 (1,405-1,426) for simple CHD vs. 246 (246-247) for non-CHD children (p<0.001). The rates of physician claims and drug-dispensing also demonstrated similar patterns. The median total hospitalization length of stay during the first year of life was 54 days (IQR: 26-95) in SV, 15 (4-39) in moderate-complex, and 6 (2-26) in simple CHD compared with 2 (1-3) among non-CHD children (p<0.001). These differences remained throughout the first five years of life, with CHD children having consistently higher hospitalization rates and ED visit rates in every year of age compared to non-CHD children. In the first year of life, median (IQR) cost per child, excluding drug costs, was $224,324 ($127,596-$312,077) in the SV group, $51,514 ($12,992-$123,332) in moderate-complex CHD, $16,274 ($6,921-$60,069) in simple CHD, and $2,918 ($1,937-$5,480) for non-CHD children (p<0.001). Hospitalizations accounted for the majority of total cost (79.2-84.4% in CHD children vs. 56.4% in non-CHD children). Cumulative HRU is high among CHD children in the first five years of life and increases with increasing CHD severity. As survival rates of children with SV lesions improve, health care systems will require increasing resource allocation to this group.View Large Image Figure ViewerDownload Hi-res image Download (PPT)