Newborn CF screening tied to lower health costs in 1st year of life
Study in France finds fewer inpatient hospitalizations for infants diagnosed
Among methods used to diagnose cystic fibrosis (CF) in France, newborn screening (NBS) was associated with the lowest healthcare expenses during the first year of life, according to a large, population-based study.
Fewer inpatient hospitalizations primarily drove the lower costs when infants were diagnosed via NBS, the data showed.
“Our study adds new knowledge of direct HC [healthcare] costs involved in young [CF children] and shows that diagnosis of CF by NBS confers the lowest HC expenses during the early years of life,” the scientists wrote.
The study, “Newborn Screening for Cystic Fibrosis Is Associated With the Lowest Healthcare Costs: A 10-Year Observational Follow-Up Study in France,” was published in Pediatric Pulmonology.
In many countries, hospital-born babies undergo NBS to identify serious health conditions at birth, including CF. NBS for CF has been associated with several clinical benefits, including better lung function, improved nutrition, and reduced mortality. Detecting the condition as soon as possible means infants can begin early CF treatment and avoid serious CF-related complications.
Study tracked 10 years of treatment
“While knowing the clinical advantages of NBS for CF, there is no data on the HC costs generated by this approach, and how it compares with other diagnosis circumstances,” the researchers wrote. They investigated healthcare costs over the first 10 years of life in children with CF since the introduction of NBS in France in 2002.
The team retrospectively examined two datasets: the French CF Registry (FCFR), which gathers clinical information on children with CF born in one of 37 French CF centers, and the Système National des Données de Santé (SNDS), a French National Health Insurance database covering nearly the entire French population.
Researchers assessed data from 779 CF children born between 2006 and 2011 with at least 10 years of follow-up. For most children, CF diagnosis was based on NBS (77.2%), followed by post-birth meconium ileus (13%), a bowel obstruction caused by excessively thick meconium (first stool); before birth (5%); or after birth, based on symptoms (4.9%).
Overall, healthcare costs followed a similar pattern across the four diagnostic groups. Costs were highest in the first year of life, decreased during the second year, and increased steadily until year 10. Still, the different diagnostic methods led to differences in cost patterns.
During the first year, mean annual costs per patient were significantly lower in the NBS group compared with the other groups — €12,056 ($13,680) versus €13,861 to €20,752 ($15,729 to $23,549). Most of these costs were driven by hospitalizations, which occurred less frequently in the NBS group (51.6%) than in the other diagnostic groups (65.4% to 78.7%).
From the second year to the 10th year, the proportion of hospital stays significantly dropped in the NBS group, falling from 30.8% to 25.5%, and the meconium ileus group, which saw a decline from 31% to 25.6%. But in the before-birth diagnosis group, the figure rose from 23.3% to 31%.
For all groups, the proportion of medication costs increased during this period: NBS (26.7% to 47.2%), meconium ileus (29% to 49.1%), and before-birth diagnosis (32.2% to 40.2%).
During the 10th year, mean annual healthcare costs were similar between the groups, ranging from €19,083 (about $22,317) for the NBS group to €22,954 (about $26,844) in the meconium ileus group.
Total healthcare costs per year and per patient fell into three distinct groups with different cost patterns: low initial costs that remained steady, high initial costs followed by a gradual increase, and the highest initial costs with the steepest increase over time.
In the low-cost group, the mean cost was about €11,015 (about $12,881) in the first year and rose slightly to €12,948 (about $15,144) in the 10th year. In the high-cost group, the first-year mean cost was about €20,000 (about $23,392), which rose to €32,987 (about $38,581) in the 10th year. The mean cost in the highest cost group was also about €20,000 in the first year, but rose to €64,233 (about $75,123) in the 10th.
In the first year, hospitalizations drove most of these costs, accounting for 54.1% of those in the low-cost group, 60.4% in the high-cost group, and 58.5% in the highest-cost group. From the second to the tenth year, the proportion of hospitalization costs decreased as medical visits increased.
When the clinical characteristics for each cost group were compared, CF children in the high and highest cost groups experienced a worse disease course than the low-cost group.
This included more severe lung disease, pancreatic insufficiency, less growth and weight gain, early infections with Pseudomonas aeruginosa — a major cause of lung infections in CF patients — and more intravenous (into-the-vein) antibiotics.
“By linking patient registry data and health claims, we found that HC costs varied depending on the diagnosis circumstances, with NBS being associated with the lowest HC costs at the beginning of life,” the team concluded.
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