Predicting Out-of-Pocket Costs in the Surgical Management of Orofacial Clefts

Sir: Orofacial clefts affect roughly 6800 births annually in the United States, and cleft repair is estimated to cost 13, 405 over an initial 12-month treatment period. 1–3 Although the lifetime expense of treating an orofacial cleft may reach 101, 000, the portion a family may expect to contribute remains unclear. 1 The purpose of this study is to estimate average out-of-pocket costs families incur during the repair of a unilateral cleft lip–cleft palate throughout the first year of life. The investigators retrospectively analyzed medical records and a hospital billing database for 18 patients treated at a single institution for an isolated, unilateral cleft lip–cleft palate. Interventions such as surgical procedures and office visits were reviewed, from the initial plastic surgery consultation through palate repair at 1 year of age. Payments received directly from patients' families were identified for each service rendered using the hospital billing database IDXterm, version 5 (IBM Corp. , 1982, 2008). Transportation costs were calculated using the patient's home address and 2009 national average fuel prices. Primary outcomes included out-of-pocket expenses (copayments) attributed to office visits, surgical fees, and transportation. Means and standard deviations were calculated for each outcome. Demographic data were compared using unpaired t tests. Eighteen patients were included in this study during the management of their unilateral cleft lip–cleft palate, and outcomes were assessed through the patient's first year of life. The average subject attended 8 ± 3. 5 office visits and required two operations to repair their cleft lip, cleft palate, and nose. Each patient was 4. 8 ± 1. 3 months of age at the time of his or her first surgical intervention. The initial operations consisted of 18 unilateral lip repairs and rhinoplasties, and the secondary operations consisted of 18 palatoplasties with 10 tympanostomy tube placements. All operations were completed before the patient turned 12 months of age. Each operation resulted in an overnight hospital stay. Including all patients (n = 18), each family paid an average of 190 (range, 0 to 810): 79 for office visits (range, 0 to 395), 72 (range, 0 to 375) in surgical fees, and 39 (range, 8 to 60) to cover transportation during treatment. Patients with private medical insurance incurred greater total out-of-pocket costs, 270, compared with those enrolled in Medicaid, 44. Under private insurance, the family contributed 110 (range, 40 to 395) for office visits, 95 (range, 0 to 375) for surgery, and 50 (range, 12 to 56) for transportation (Table 1). Subjects with insurance coverage through Medicaid spent 12 (range, 0 to 70) on office visits, 21 (range, 0 to 127) on surgery, and 16 (range, 8 to 59) on transportation. The total office visit expense was significantly greater for patients with private insurance compared with those with Medicaid (p = 0. 040) ; however, differences in the amount paid for surgery and transportation did not achieve significance between these patient populations (p = 0. 15 and p = 0. 13, respectively). Table 1: Out-of-Pocket Costs for Subjects with Private Insurance versus MedicaidAlthough the costs of unilateral cleft lip–cleft palate repair are substantial, families contribute a small percentage over the course of treatment as determined by the specific medical insurance carrier. These findings provide a framework for physicians to predict the financial burden a family may expect to incur and allow families to prepare for inevitable costs. DISCLOSURE The authors have no financial interests to declare. Frank P. Albino, B. S. Peter F. Koltz, M. D. John A. Girotto, M. D. Division of Plastic Surgery University of Rochester Medical Center Rochester, N. Y.