Health care expenditures of children and adults with spina bifida in a privately insured U.S. population

BACKGROUND: We provide new estimates of medical care utilization and expenditures over the lifespan for persons living with spina bifida in the United States. Updated estimates are essential for calculations of lifetime costs and for economic evaluations of prevention and management strategies for spina bifida. METHODS: We analyzed data from the 2001-2003 MarketScan database on paid medical and prescription drug claims of persons covered by employer-sponsored health insurance in the United States. Medical care utilization and expenditures during 2003 were analyzed for persons with a diagnosis of spina bifida recorded during 2001-2003 who had 12 months of coverage in a fee-for-service health plan. To calculate expenditures during infancy, a separate analysis was performed for those born during 2002 with claims and expenditures data during the first 12 months of life. We compared medical expenditures for persons with and without spina bifida by age groups. RESULTS: Average incremental medical expenditures comparing patients with spina bifida and those without were 41, 460 per year at age 0, 14, 070 at ages 1-17, 13, 339 at ages 18-44, and 10, 134 at ages 45-64. Children ages 1-17 years with spina bifida had average medical expenditures 13 times greater than children without spina bifida. Adults with spina bifida had average medical expenditures three to six times greater than adults without spina bifida in this privately insured population. CONCLUSIONS: Although per capita medical care utilization and expenditures are highest among children, adults constitute an important and growing share of the population living with spina bifida.