Nephrology 6: Glomerular/Clinical and Basic Science
66 - Out of Pocket Spending and Health Care Utilization among Commercially Insured Children with Nephrotic Syndrome
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 66 Publication Number: 66.351
Zubin J. Modi, University of Michigan Medical School, Ann Arbor, MI, United States; Kayla Sifre, University of Michigan Medical School, Ann Arbor, MI, United States; Eloise Salmon, University of Michigan Medical School, Ann Arbor, MI, United States; Kevin Dombkowski, University of Michigan Medical School, Ann Arbor, MI, United States; Debbie S. Gipson, University of Michigan, Ann Arbor, MI, United States
Assistant Professor University of Michigan Medical School Ann Arbor, Michigan, United States
Background: Children with nephrotic syndrome (NS) have high levels of inpatient health care utilization and indirect economic burdens. The degree of outpatient health care utilization and costs, particularly the burden of out-of-pocket (OOP) spending is unknown. Objective: To evaluate insurance reimbursed costs, out of pocket spending, and health care utilization among commercially insured pediatric NS patients in the US. Design/Methods: All claims from the Truven MarketScan Commercial database for pediatric patients between 2009 and 2018, including subsequent adult data on transitioned pediatric patients within the study period were used. NS patients were identified using validated ICD-9/10 codes. Patients with less than 6 months of insurance coverage on file or records used for solely administrative corrections were excluded. Both OOP and total insurance payments were calculated, as well as the number of outpatient visits (inclusive of emergency department visits), inpatient visits, and the length of each inpatient stay. Results: 8,937 (0.02%) of the pediatric population of 42,051,432 were identified as NS patients. 6,678 of those identified met our inclusion criteria. Patients had a median of 9.7 outpatient visits per year and 0.4 inpatient visits per year, with a median inpatient stay length of 3.0 days. The median NS patient spent 1.1 days in the hospital each year. The median total annual per patient cost to the insurer was $2,383 for outpatient care and $4,488 for inpatient care. The median OOP cost for a single inpatient visit was $719. The median insurance reimbursed cost for a single inpatient visit was $10,751. Overall, total OOP expenses for the pediatric NS population were $20,037,024. The median yearly OOP cost per patient was $705 with $433 for outpatient and $272 for inpatient.
Conclusion(s): Most pediatric NS patients receive the majority of their care as outpatients. While NS patients typically spend more OOP annually on outpatient versus inpatient services,a single inpatient stay surpasses these costs. These findings highlight the importance of strategies to keep children with NS out of the hospital when possible, recognizing the additional financial burdens added to the multiple difficulties hospitalized children with NS face.
