Cost Comparison of Prenatal Myelomeningocele Closure Versus Postnatal Closure for Both Mother and Child at 1 year of Life. (1st September 2019)

• Record Type: Journal Article
• Authors: Kessler, Brice A; Quinsey, Carolyn; Goodnight, William; Elton, Scott
• Is Part Of: Neurosurgery. Volume 66(2010)Supplement 1
• Publication Date: 2019-09-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyz310_199
• Languages: English
• ISSNs: 0148-396X

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.