The cumulative healthcare costs for infants with biliary atresia can increase substantially if they undergo their initial treatment, the Kasai surgery, after 2 months of age, according to an analysis of U.S. private-payer insurance claims.
Higher healthcare costs in the first year of life was also found for infants who had been admitted to neonatal intensive care and who reside in rural areas compared with those who live in urban centers, data show.
“Early BA [biliary atresia] diagnosis is integral to optimizing outcomes and minimizing healthcare expenditures,” researchers wrote.
The study, “The Age-stratified Cost of Biliary Atresia: A MarketScan-Based Cost Analysis,” was published in the Journal of Pediatric Surgery.
Biliary atresia is a rare liver disease that affects infants. It occurs when the bile ducts, which carry the digestive fluid bile from the liver to the small intestine, are blocked or missing. This prevents bile from draining, causing it to build up and damage the liver.
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First-line treatment for biliary atresia is Kasai procedure
The first-line treatment is the Kasai procedure, or Kasai portoenterostomy (KP), a surgery that aims to restore bile flow by creating an alternate route into the small intestine that bypasses the blocked ducts. The surgery is most effective when performed at the earliest age to preserve liver health and avoid the need for a liver transplant.
“However, a cost comparison of outcomes for early versus late KP is necessary to justify resource investment in universal screening,” the researchers wrote.
With this in mind, the team, from The University of Utah, retrospectively assessed the healthcare costs of biliary atresia in the U.S from the payer perspective based on the age at which the surgery was performed. Using the nationwide MarketScan healthcare claims database, they identified 170 infants diagnosed with biliary atresia.
Half (50.6%) underwent early KP, or before 60 days of age, and 45.9% underwent late KP, at 60 days or older. Six infants (3.5%) underwent liver transplant without prior KP.
The researchers noted the number of infants enrolled in the insurance database markedly dropped over the study period. From the 170 initially, 101 infants (59.4%) were enrolled at one year, 45 (26.4%) at three years, and 23 (13.5%) at five years. Therefore, cumulative costs were calculated at these time points.
“It is, perhaps, most concerning that patients and families burdened with this high-cost, resource-intensive [disease] experience insurance discontinuity at an alarming rate,” the researchers wrote.
Late Kasai surgery linked to need for liver transplant within 3 years
In line with established data, infants who underwent late KP were twice as likely to need a liver transplant within three years compared with those who underwent the surgery before 60 days (41% vs. 23%).
The average cumulative inpatient, outpatient, and pharmaceutical costs across all biliary atresia patients, including those who underwent transplants, were $237,344 at one year, $420,323 at three years, and $522,656 in the first five years of life.
The researchers then conducted a statistical analysis of the data that was adjusted for potential influencing factors, including prior admission to a neonatal intensive care unit (NICU), heart defects at birth, BA-related spleen abnormalities, and an urban versus rural home address.
Those undergoing late KP accumulated an additional mean of $514,243 in healthcare costs at three years compared with those undergoing early KP. Also, undergoing a liver transplant within three years was associated with an additional $826,505 relative to early KP.
In the first year, a prior NICU stay was significantly linked with higher total cumulative costs, by $346,274. This finding, the team noted, was unsurprising and aligned with “prior reports of disproportionate costs associated with [birth] anomalies and NICU admissions.”
Moreover, children with urban home addresses had lower overall costs, by $101,191, than their rural counterparts, which supports the notion that “vulnerable populations living in remote geographic areas are at particularly high risk for poor health outcomes and high resource utilization,” the researchers wrote.
As anticipated, the one- and three-year predicted costs increased over time and across all groups. Predicted total costs at three years (without a transplant) were significantly lower for the early KP group relative to the late KP group ($283,035 vs. $738,958). Also, at three years, the predicted healthcare costs for infants undergoing liver transplant, regardless of KP status, was $1,015,806.
“Cumulative healthcare costs for children with BA increase with delayed diagnosis and older age at KP and highlight the urgent need for systematic health policy initiatives aimed at improving the early identification of this high-risk population,” the researchers concluded.
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