Health Care Costs For Children Research Articles

Prenatal Intravenous Magnesium at 30–34 Weeks' Gestation and Neurodevelopmental Outcomes in Offspring: The MAGENTA Randomized Clinical Trial

(Abstracted from JAMA 2023;330(7):603–614) Preterm birth is a focus of many studies and interventions but remains the leading cause of global neonatal morbidity and mortality. One particular risk that is elevated in preterm infants is cerebral palsy, which affects movement and/or posture, causing health problems and high health care costs for children and their families.

Health economic analysis and medical cost analysis of children with severe hepatitis B in China: A retrospective study from 2016 to 2022.

Hepatitis B poses a heavy burden for children in China, however, the national studies on the distributional characteristics and health care costs of children with severe hepatitis B is still lacking. This study aimed to analyze the disease characteristics, health economic effects, and medical cost for children with severe hepatitis B in China. Based on patient information in the Hospital Quality Monitoring System, cases with severe hepatitis B were divided into four groups according to age, and the etiology and symptoms of each group were quantified. The cost of hospitalization was calculated for cases with different disease processes, and severity of disease. The spatial aggregation of cases and the relationship with health economic factors were analyzed by Moran's Ianalysis. The total number of children discharged with hepatitis B from January 2016 to April 2022 was 1603, with an average age of 10.5 years. Liver failure cases accounted for 43.48% (697/1603,) of total cases and cirrhosis cases accounted for 11.23% (180/1603,). According to the grouping of disease progression, there were 1292 cases without associated complications, and the median hospitalization cost was $818.12. According to the spatial analysis, the aggregation of cases was statistically significant at the prefectural and provincial levels in 2019, 2020, and 2021 (all P <0.05). The number of severe cases was negatively correlated with gross domestic product (GDP, Moran's I <0) and percentage of urban population (Moran's I <0), and positively correlated with the number of pediatric beds per million population (Moran's I >0). The number of severe hepatitis B cases is low in areas with high GDP levels and high urban population ratios, and health care costs have been declining over the years.

The impact of urban family physician program on health service access and utilization in Iranian children and adolescents: Results of the national health services utilization survey in 2015

Background. The Urban Family Physician Program (UFPP) has been implemented in Fars and Mazandaran provinces of Iran since 2013 with the aim of improving access and utilization of health services, with a particular focus on children and adolescents. In order to evaluate the effectiveness of the program in achieving this goal, this study aimed to compare the access and utilization of health services among children living in areas covered by the UFPP with those living in other regions of Iran. Methods. A secondary analysis was performed using data from the 2015 National Health Utilization Survey. The data of people aged under 18 were extracted and indicators on the use of health services based on three main models of health service provisions were compared: (1) cities in Fars and Mazandaran provinces (UFPP implemented); (2) cities in other Iranian provinces (excluding Fars and Mazandaran); and (3) villages and cities with a population under 20,000. Results. The study included 20,689 children. The outpatient and inpatient visits in children living in Fars and Mazandaran provinces were higher than in children from other provinces and smaller towns (11.89 vs. 7.92 and 7.21 for outpatient and 4.74 vs. 3.51 and 4.27 for inpatient, respectively). Furthermore, UFPP was found to be associated with a higher utilization of health services in children residing in cities (odds ratio=1.50 (1.98-1.15)). Additionally, the cost of outpatient and inpatient health services in areas where the UFPP was implemented was lower compared to other parts of the country. Conclusion. The urban family physician program has been successful in increasing the access to health services and reducing health costs in children. Practical Implications. The findings suggest that the urban family physician program can be an effective strategy for improving healthcare access and reducing costs, especially in areas with high population density. Policymakers and healthcare providers can use the results of this study to inform the development and implementation of similar programs in other countries, with the aim of improving healthcare access and reducing healthcare costs in children and adolescents.

The Impact of Teduglutide on Real-Life Health Care Costs in Children with Short Bowel Syndrome

ObjectivesTo analyze the real-life health care costs of home parenteral nutrition (HPN) in children with short bowel syndrome with intestinal failure (SBS-IF) before and after treatment with teduglutide, and to compare those with costs of children with SBS-IF not treated with teduglutide. Study DesignAll consecutive children with SBS-IF on HPN treated with subcutaneous teduglutide starting from 2018 through 2020 in a tertiary French referral center were retrospectively included. These patients were matched to children with SBS-IF on HPN followed during the same 3-year period who were eligible for the teduglutide but were not treated. HPN direct medical costs included: home-care visits, HPN bags, hospital admissions, and teduglutide. A comparison of costs before/after treatment, and between patients treated/not treated was performed. ResultsSixty children were included: 30 (50%) treated with teduglutide and 30 (50%) untreated. In the treated group, the median total costs of HPN significantly decreased after 1 (p<0.001) and 2 years of treatment (p<0.001) from 59.454 euros/year/patient to 43.885 euros/year/patient and 34.973 euros/year/patient, respectively. Comparing patients treated and not treated, the total HPN costs/year/patient were similar at baseline (p=0.6) but were significantly lower in the teduglutide-treated group after 1 (p=0.006) and 2 years of treatment (p<0.001). When adding the cost of teduglutide into the analysis, the total cost increased significantly in the treated group, and remained much higher even after modeling a reduction in the cost of the drug to 1/3 the present cost and PN weaning (p<0.001). ConclusionsTreatment with teduglutide is associated with a significant reduction in the annual costs of HPN but still remains expensive because of the drug itself. Finding cost saving strategies is essential.

The association between household food insecurity and healthcare costs among Canadian children.

To examine the relationship between household food insecurity and healthcare costs in children living in Ontario, Canada. We conducted a cross-sectional, population-based study using four cycles of the Canadian Community Health Survey (2007-2008, 2009-2010, 2011-2012, 2013-2014) linked with administrative health databases (ICES). We included Ontario children aged 1-17years with a measure of household food insecurity (Household Food Security Survey Module) over the previous 12months. Our primary outcome was the direct public-payer healthcare costs per child over the same time period (in Canadian dollars, standardized to year 2020). We used gamma-log-transformed generalized estimating equations accounting for the clustering of children to examine this relationship, and adjusted models for important sociodemographic covariates. As a secondary outcome, we examined healthcare usage of specific services and associated costs (e.g. visits to hospitals, surgeries). We found that adjusted healthcare costs were higher in children from food-insecure than from food-secure households ($676.79 [95% CI: $535.26, $855.74] vs. $563.98 [$457.00, $695.99], p = 0.047). Compared with children living in food-secure households, those in insecure households more often accessed hospitals, emergency departments, day surgeries, and home care, and used prescription medications. Children from food-secure households had higher usage of non-physician healthcare (e.g. optometry) and family physician rostering services. Even after adjusting for measurable social determinants of health, household food insecurity was associated with higher public-payer health services costs and utilization among children and youth. Efforts to mitigate food insecurity could lessen child healthcare needs, as well as associated costs to our healthcare systems.

The Economic Burden of Bronchiectasis: A Systematic Review

Bronchiectasis, a previously neglected condition, now has renewed research interest. There are a few systematic reviews that have reported on the economic and societal burden of bronchiectasis in adults, but none have reported on children. We undertook this systematic review to estimate the economic burden of bronchiectasis in children and adults. What is the health care resource utilization and economic burden of bronchiectasis in adults and children? We performed a systematic review identifying publications from Embase, PubMed, Web of Science, Cochrane (trials, reviews, and editorials), and EconLit about the economic burden and health care utilization in adults and children with bronchiectasis between January 1, 2001, and October 10, 2022. We used a narrative synthesis approach and estimated aggregate costs for several countries. We identified 53 publications reporting on the economic burden and/or health care utilization of people with bronchiectasis. Total annual health care costs per adult patient ranged from 2021 $3,579 to $82,545 USD and were predominantly driven by hospitalization costs. Annual indirect costs including lost income because of illness (reported in only five studies) ranged from $1,311 to $2,898 USD. Total health care costs in children with bronchiectasis were $23,687 USD annually in the one study that estimated them. Additionally, one publication found that children with bronchiectasis missed 12 school days per year. We estimated aggregate annual health care costs for nine countries, ranging from $101.6 million per year in Singapore to $14.68 billion per year in the United States. We also estimated the aggregate cost of bronchiectasis in Australian children to be $17.77 million per year. This review highlights the substantial economic burden of bronchiectasis for patients and health systems. To our knowledge, it is the first systematic review to include the costs for children with bronchiectasis and their families. Future research to examine the economic impact of bronchiectasis in children and economically disadvantaged communities, and to further understand the indirect burden of bronchiectasis on individuals and the community, is needed.

Costs of Healthcare for Children with Inflammatory Bowel Diseases (IBD) in Poland.

The last two decades have seen an increase in the incidence of inflammatory bowel disease (IBD) in many regions of the world, which has had a significant impact on both the social and economic burden of governments and healthcare systems. The aim of this study was to determine the level of hospitalization and outpatient treatment costs for children and adolescents with Crohn's disease and ulcerative colitis, depending on age, location, and activity of the disease. Methods were a retrospective analysis of the medical documentation of 240 children with IBD, hospitalized in the Gastroenterology Ward, Department of Pediatrics Medical University of Silesia (Katowice, Poland), along the three years follow up. The costs of treatment consisted of calculations of the supply of oral and intravenous drugs, calculations of the costs of laboratory tests, imaging, and consultations, as well as person-day costs. The most important results, determined with high costs of IBD treatment, are associated with younger age, high disease activity, localization in the small intestine in Crohn's disease (CD), and inflammatory changes in the entire colon in Ulcerative Colitis (UC). During the observation, it was noticed that the shortening of the hospitalization time did not significantly affect the total costs, which remained at a stable level.

Severe pediatric asthma therapy: Dupilumab.

Severe asthma is a rare disease affecting <5% of children with asthma. This group of patients account for about 50% of the costs of healthcare for children with asthma. Nowadays, several biological agents are available for pediatric severe asthma. One of these is dupilumab, a monoclonal antibody against the Interleukin (IL)-4 receptor α-subunit that acts as an antagonist against both IL-4 and IL-13. Dupilumab binds the subunit of the IL-4 receptor, at the level of the subunit shared by the IL-13 receptor, blocking the inflammatory cascade of these two cytokines and the progression of the Th2-inflammatory pathway. The efficacy and safety of dupilumab have been investigated in recently published randomized controlled trials including pediatric patients with asthma. Currently, its use in asthma is approved in adults, adolescents, and children with severe asthma with type 2 inflammation, that are not controlled in spite of high-dose inhaled corticosteroids plus another maintenance drug. Studies are warranted for the evaluation of long-term treatment with dupilumab, including steroid sparing effect and discontinuation of treatment. Further research should also be planned in order to investigate dupilumab potential ability to interfere with the natural history of atopy since early childhood.

Cost-effectiveness of perampanel as an adjunctive treatment for uncontrolled focal seizures in pediatric patients: a Chinese perspective.

BackgroundThe incidence of epilepsy is 41–187 per 100,000 person-year in children. The health care costs for children with uncontrolled epilepsy is a huge burden. Perampanel (PER) was effective, safety and well-tolerated as add-on therapy in pediatric patients aged 4 to <12 years with uncontrolled focal seizures. However, there is still limited evidence on cost-effectiveness of PER in pediatric patients. We aimed to evaluate the cost-effectiveness of PER as an add-on therapy for pediatric patients with uncontrolled focal seizures.MethodsA Markov model was established to conduct an analysis from the perspective of the Chinese health system and society. The incremental cost-effectiveness ratio (ICER) of patients using PER and conventional therapy versus patients using conventional therapy alone were estimated and compared. The transition probability of the response level, health state utility values, and costs were derived from clinical trials and the literature. Costs, including medical, drug, transportation and indirect costs, were calculated. We performed 1-way sensitivity analyses and probabilistic sensitivity analyses. A subgroup analysis of different ages was also conducted.ResultsThe base-case analysis indicated that compared to maintaining conventional therapy, adding PER as an adjuvant drug therapy had an increased cost of $3,449.85 over 5 years, with an incremental quality-adjusted life years (QALY) value of 0.40, resulting in an ICER of $8,582.58 per additional QALY. The health state utility value had the greatest effect on the ICER. The probabilistic sensitivity analyses showed that the probability of PER being cost-effective was 76.72% at a willingness-to-pay of $11,293/QALY. The ICER of the subgroup ranged from $7,167.95/QALY to $19,710.96/QALY.ConclusionsOur study demonstrated that PER is a cost-effective add-on therapy for pediatric patients.

Direct Costs of Healthcare for Children with Type 1 Diabetes Using a CGM System: A Health Economic Analysis of the VIDIKI Telemedicine Study in a German Setting.

The Virtual Diabetes Outpatient Clinic for Children and Adolescents (VIDIKI) study was a 6-month quasi-randomized, multicentre study followed by an extension phase to evaluate the effects of monthly video consultations in addition to regular care. A health economic analysis was conducted to assess the direct costs. The cost data of 240 study participants (1-16 years of age) with type 1 diabetes who were already using a continuous glucose monitoring system were collected in the first 6 months of the study. The intervention group (IG) received monthly video consultations plus regular care, and the waiting control group (WG) received only regular care. Cost data were collected for a comparable anonymized group of children from the participating health insurance companies during the 6-month period before the study started (aggregated data group [AG]). Cost data were analysed for the AG (N=840) 6 months before study initiation and those for the study participants (N=225/240). Hospital treatment was the highest cost category in the AG. There was a cost shift and cost increase in the IG and WG, whereby diabetes supplies were the highest cost category. The mean direct diabetes-associated 6-month costs were € 4,702 (IG) and € 4,936 (WG). The cost development within the cost collection period over two years possibly reflects the switch to higher-priced medical supplies. Video consultation as an add-on service resulted in a small but nonsignificant reduction in the overall costs.

Cyclic Vomiting Syndrome-Related Hospitalizations Trends, Comorbidities & Health Care Costs in Children: A Population Based Study.

Aim: To analyze the clinical characteristics, trends in hospitalization and health care resource utilization of pediatric patients with cyclical vomiting syndrome (CVS). Methods: We analyzed the latest 5 Healthcare Cost and Utilization Project-Kids Inpatient Database (HCUP-KID) datasets including years 2003, 2006, 2009, 2012 and 2016 for patients aged 1–20 years with a primary diagnosis of CVS and were compared with Age/gender-matched controls for comorbidities, clinical outcomes, and healthcare resource utilization. Results: A total of 12,396 CVS-related hospitalizations were analyzed. The mean age of CVS patients was 10.4 ± 6.7 years. CVS was associated with dysautonomia (OR: 12.1; CI: 7.0 to 20.8), dyspepsia (OR: 11.9; CI: 8.8 to 16.03), gastroesophageal reflux disease (OR: 6.9; Confidence Interval (CI): 6.4 to 7.5), migraine headaches (OR: 6.8; CI: 5.9 to 7.7) and irritable bowel syndrome (OR: 2.08; CI: 1.2 to 4.3) (all p < 0.001). CVS was also associated with increased cannabis use (OR: 5.26, 4.6 to 5.9; p < 0.001), anxiety disorder (OR: 3.9; CI: 3.5 to 4.4) and stress reaction (OR: 3.6; CI: 2.06 to 6.3), p < 0.001. Mean CVS-related hospitalization costs (inflation adjusted) more than doubled from $3199 in 2003 to $6721 in 2016, incurring $84 million/year in total costs. Conclusion: Hospitalized CVS patients have increased prevalence of DGBIs, dysautonomia, psychiatric conditions and cannabis use compared to non-CVS controls. CVS-related hospitalizations in U.S. is associated with increasing health care costs. Better management of CVS and comorbid conditions is warranted to reduce health care costs and improve outcomes.

Impact of tonsillotomy versus tonsillectomy on health-related quality of life and healthcare costs in children with sleep-disordered breathing.

AbstractObjectiveThis study aimed to explore health-related quality of life and use of healthcare services and ensuing costs before and after tonsillotomy in children with sleep-disordered breathing and to compare the results to an earlier cohort of children who had undergone tonsillectomy.MethodChildren undergoing tonsillotomy answered the 17-dimensional, standardised health-related quality of life instrument questionnaire and a questionnaire on use of healthcare services and sick leave before and after surgery. Costs of specialist care were obtained pre- and post-operatively. The data were compared with similar data collected previously from children with tonsillectomy.ResultsTonsillotomy improved mean total health-related quality of life score significantly at 6 and 12 months. Healthcare costs and number of sick-leave days diminished significantly from 3 months pre-operatively to 12 months after surgery. Tonsillotomy had similar positive effects compared with tonsillectomy regarding health-related quality of life and healthcare costs.ConclusionTonsillotomy improves health-related quality of life in children with sleep-disordered breathing and reduces healthcare service needs and sick leave similarly to tonsillectomy.

Epidemiology, healthcare resource utilization and healthcare costs for spinal muscular atrophy in Alberta, Canada

Aims Spinal muscular atrophy (SMA) is a progressive neuromuscular disease associated with the degeneration of motor neurons in the brainstem and spinal cord. Studies examining the epidemiology and economic impact of SMA are limited in Canada. This study aimed to estimate the epidemiology as well as healthcare resource utilization (HRU) and healthcare costs for children with SMA in Alberta, Canada. Materials and methods We conducted a retrospective study using anonymized data from administrative healthcare databases provided by Alberta Health. Data from 1 April 2010 to 31 March 2018, were extracted for patients <18 years of age identified with SMA. Five-year incidence and prevalence were calculated for cases identified between 1 April 2012 and 31 March 2017. HRU and healthcare costs were assessed one year after SMA diagnosis, including hospitalizations, physician visits, ambulatory care visits and long-term care admissions. Results The five-year incidence and prevalence of pediatric onset SMA were 1.03 per 100,000 person-years and 9.97 per 100,000 persons, respectively. General practitioner, specialist, and ambulatory care visits were common among children with SMA in the first-year post-diagnosis. The mean (SD) total annual direct cost per patient in the first-year post-diagnosis was $29,774 ($38,407); hospitalizations accounted for 41.7% of these costs ($12,412 [$21,170]), followed by practitioner visits at 32.3% ($9,615 [$13,054]), and ambulatory care visits at 26.0% ($7,746 [$9,988]). Conclusions Children with SMA experience substantial HRU, particularly for hospitalizations and practitioner visits, following diagnosis. Given the high costs of SMA, timely access to effective treatment strategies, such as the novel survival motor neuron (SMN)-restoring treatments recently approved for use, are needed to improve health outcomes and HRU.

Individual and Nationwide Costs for Cancer Care During the First Year After Diagnosis Among Children, Adolescents, and Young Adults in Japan.

There has been limited information on the economic evaluation of children, adolescents, and young adults (AYAs) with cancer. The aim of this study was to estimate the individual and nationwide costs for cancer care during the first year after diagnosis among children and AYAs in Japan. We estimated the direct health care costs for children (0-14 years old) and AYAs (15-29 years old) from the perspective of the public payer. Children and AYAs with newly diagnosed cancer between April 2016 and March 2018 were identified from the Diagnosis Procedure Combination Study Group database to calculate the cost per patient. The nationwide cost was estimated by the bottom-up approach, using stratification by age group, sex, and cancer classification, based on Population Estimates and Cancer Statistics data. A total of 2,939 children and 5,512 AYAs were identified. The median 1-year cost per patient after diagnosis was 2,832,840 (interquartile range, 927,490-9,222,780) JPY (in USD: median, 28,047; interquartile range, 9,183-91,310). The median 1-year cost per patient was higher in children than in AYAs in all cancer classifications. Leukemia, treatment in cancer centers, and early death as well as longer hospital stay were identified to have an impact on 1-year cost per patient after diagnosis. The 1-year nationwide cost after diagnosis was estimated as 34.83 × 109 JPY (344.8 × 106 USD). We showed that cancer treatments for both children and AYAs were highly cost-intensive in Japan. Our results suggest the need for further financial and policy evaluation.

Parent Preferences for Transparency of Their Child’s Hospitalization Costs

Health care in the US is often expensive for families; however, there is little transparency in the cost of medical services. The extent to which parents want cost transparency in their children's care is not well characterized. To explore the preferences and experiences of parents of hospitalized children regarding the discussion and consideration of health care costs in the inpatient care of their children. This cross-sectional multicenter survey study included 6 geographically diverse university-affiliated US children's hospitals from November 3, 2017, to November 8, 2018. Participants included a convenience sample of English- and Spanish-speaking parents of hospitalized children nearing hospital discharge. Data were analyzed from January 1, 2020, to June 25, 2021. Parents' preferences and experiences regarding transparency of their child's health care costs. Multivariable linear regression examined associations between clinical and sociodemographic variables with parents' preferences for knowing, discussing, and considering costs in the clinical setting. Factors included family financial difficulties, child's level of chronic disease, insurance payer, deductible, family poverty level, race, ethnicity, parental educational level, and study site. Of 644 invited participants, 526 (82%) were enrolled (290 [55%] male), of whom 362 (69%) were White individuals, 400 (76%) were non-Hispanic/Latino individuals, and 274 (52%) had children with private insurance. Overall, 397 families (75%) wanted to discuss their child's medical costs, but only 36 (7%) reported having a cost conversation. If cost discussions were to occur, 294 families (56%) would prefer to speak to a financial counselor. Ninety-eight families (19%) worried discussing costs would hurt the quality of their child's care. Families with a medical financial burden unrelated to their hospitalized child had higher mean agreement that their child's physician should consider the family's costs in medical decision-making than families without a medical financial burden (effect size, 0.55 [95% CI, 0.18-0.92]). No variables were consistently associated with cost transparency preferences. Most parents want to discuss their child's costs during an acute hospitalization. Discussions of health care costs may be an important, relatively unexplored component of family-centered care. However, these discussions rarely occur, indicating a tremendous opportunity to engage and support families in this issue.

Patterns of Congenital Heart Disease Among Patients Attending in Specialized Hospitals

Background: Incidence of congenital heart disease is serious and common conditions that have significant impact on morbidity, mortality and healthcare costs in children and adults. The objective of this paper is socio-demographic characteristics, pattern, risk factors and geographical distribution of Congenital Heart Disease (CHD).&#x0D; Methods: This cross-sectional study was conducted throughout the year of 2013 in Dhaka city of Bangladesh. Among the children with confirmed diagnosis of CHD within the age ranging from birth to 18 years, admitted and treated at National Institute of Cardiovascular Disease (NICVD) and National Heart Foundation and Research Center (NHFRC) were included.&#x0D; Result: Out of 168 patients, 64% were living in rural area, 36% were living in urban. The study revealed that 58.9% of male were predominant whereas female was 41.1%. The mean (±SD) age of patients was 4.87(±2.83) years. 71.4% of the children were within 1 to 5 years of age. 36.9% CHD was diagnosed at the age of 1 - 5 years. Finding of the study revealed that there were different types of CHD namely Ventricular Septal Defect (VSD) 35.15%, Atrial Septal Defect (ASD) 27.4%, Patent Ductus Arteriosus (PDA) 13.7%, Coarctation of the aorta 4.8% and Tetralogy of Fallots 19%. In urban area, 37.4% patients had VSD while in rural area, 31.1% patients had ASD. This variation of CHD in relation to living place of the patients was statistically important (χ2 4 = 11.62, p=0.024). In female patients, VSD is more than 58%, however in male patients, ASD is more than 36.4%. This variation of CHD according to sex of the patients was statistically vital (χ2 4 = 27.85, p=0.001). Among the mothers, 39.8% utilized Ant-natal Care (ANC) had VSD while 24.0% having VSD did not utilized ANC. This variation was statistically significant (χ2 4 = 8.235, p=0.04). Among the patients, 41.7% were aged 1-5 years who had VSD while 50.0% were aged 6-10 years who had ASD. This variation was statistically important as it showed (χ2 8 = 43.601, p=0.000)&#x0D; Conclusions: As the most common type of congenital heart diseases are VSD and ASD, the findings of this study will contribute in early detection and proper management of CHD in the contexts to others and thus save lives.&#x0D; JOPSOM 2020; 39(2): 40-44

Economic burden of epilepsy in children: A population-based matched cohort study in Canada.

The economic burden of childhood epilepsy to the health care system remains poorly understood. This study aimed to determine phase-specific and cumulative long-term health care costs in children with epilepsy (CWE) from the health care payer perspective. This cohort study utilized linked health administrative databases in Ontario, Canada. Incident childhood epilepsy cases were identified from January 1, 2003 to June 30, 2017. CWE were matched to children without epilepsy (CWOE) on age, sex, rurality, socioeconomic status, and comorbidities, and assigned prediagnosis, initial, ongoing, and final care phase based on clinical trajectory. Phase-specific, 1-year and 5-year cumulative health care costs, attributable costs of epilepsy, and distribution of costs across different ages were evaluated. A total of 24411 CWE were matched to CWOE. The costs were higher for prediagnosis and initial care than ongoing care in CWE. Hospitalization was the main cost component. The costs of prediagnosis, initial, and ongoing care were higher in CWE than CWOE, with the attributable costs at $490 (95% confidence interval [CI] = $352-$616), $1322 (95% CI = $1247-$1402), and $305 (95% CI = $276-$333) per 30 patient-days, respectively. Final care costs were lower in CWE than CWOE, with attributable costs at -$2515 (95% CI = -$6288 to $961) per 30 patient-days. One-year and 5-year cumulative costs were higher in CWE ($14776 [95% CI = $13994-$15546] and $39261 [95% CI = $37132-$41293], respectively) than CWOE ($6152 [95% CI = $5587-$6768] and $15598 [95% CI = $14291-$17006], respectively). The total health care costs were highest in the first year of life in CWE for prediagnosis, initial, and ongoing care. Health care costs varied along the continuum of epilepsy care, and were mainly driven by hospitalization costs. The findings identified avenues for remediation, such as enhancing care around the time of epilepsy diagnosis and better care coordination for epilepsy and comorbidities, to reduce hospitalization costs and the economic burden of epilepsy care.

A genome-wide association study of severe asthma exacerbations in Latino children and adolescents.

Severe asthma exacerbations are a major cause of school absences and healthcare costs in children, particularly those in high-risk racial/ethnic groups.To identify susceptibility genes for severe asthma exacerbations in Latino children and adolescents, we conducted a meta-analysis of genome-wide association studies (GWAS) in 4010 Latino youth with asthma in four independent cohorts, including 1693 Puerto Ricans, 1019 Costa Ricans, 640 Mexicans, 256 Brazilians and 402 members of other Latino subgroups. We then conducted methylation quantitative trait locus, expression quantitative trait locus and expression quantitative trait methylation analyses to assess whether the top single nucleotide polymorphism (SNP) in the meta-analysis is linked to DNA methylation and gene expression in nasal (airway) epithelium in separate cohorts of Puerto Rican and Dutch children and adolescents.In the meta-analysis of GWAS, an SNP in FLJ22447 (rs2253681) was significantly associated with 1.55 increased odds of severe asthma exacerbation (95% CI 1.34-1.79, p=6.3×10-9). This SNP was significantly associated with DNA methylation of a CpG site (cg25024579) at the FLJ22447 locus, which was in turn associated with increased expression of KCNJ2-AS1 in nasal airway epithelium from Puerto Rican children and adolescents (β=0.10, p=2.18×10-7).SNP rs2253681 was significantly associated with both DNA methylation of a cis-CpG in FLJ22447 and severe asthma exacerbations in Latino youth. This may be partly explained by changes in airway epithelial expression of a gene recently implicated in atopic asthma in Puerto Rican children and adolescents (KCNJ2-AS1).

Motion-corrected cardiac MRI limits anesthesia exposure and healthcare costs in children

Motion-corrected cardiac MRI limits anesthesia exposure and healthcare costs in children

Motion-corrected cardiac MRI limits anesthesia exposure and healthcare costs in children

Purpose: The benefits of cardiac magnetic resonance (CMR) imaging in the pediatric population must be continually balanced with the risk and cost of sedation, particularly in children with cardiac disease. Current CMR imaging methods allow free-breathing, averaged imaging, however significant motion artifacts, poor signal-to-noise ratio (SNR), and lengthy scan times limit their use. Many pediatric CMR programs opt for breath-held CMR imaging using general anesthesia. The advent of new free-breathing CMR imaging techniques leveraging single-shot, motion-corrected (MOCO) sequences offer a significant opportunity to limit sedation exposure while …