Price Tag Increasing for Pediatric Pulmonary Hypertension

Diedtra Henderson

July 06, 2015

Children with pulmonary hypertension (PH) account for a small but growing number of pediatric discharges, and their annual hospitalization charges, which soared to $3.12 billion in 2012, will place ongoing pressure on resources, a study suggests.

Bryan G. Maxwell, MD, MPH, from the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues published the results of their review of administrative records online July 6 in Pediatrics.

Dr Maxwell and coauthors tapped the Kids' Inpatient Database, the nation's largest publicly available repository for pediatric inpatient care records, to characterize how PH demographics among children evolved from 1997 to 2012.

Overall, the investigators identified 56,678 discharges during the study period for children with PH, or 0.13% of 43.0 million pediatric discharges contained within the database. Annual hospitalization charges rose from $926 million in 1997 to $3.12 billion in 2012 as a result of an increase in PH discharges and higher costs per hospitalization, as well as longer hospital stays, the authors write.

Looking at the group's demographics, the authors found that children hospitalized with PH were younger and more likely to be admitted to urban teaching hospitals compared with the pediatric in-patient population as a whole. Children with PH and congenital heart disease accounted for 43% of the patients with PH, but the proportion decreased during the study period. Although fewer children with PH underwent cardiac surgical procedures, the percentage who underwent noncardiac surgical procedures rose from 3.6% at the beginning of 1997 to 12.0% by the close of 2012.

"The principal findings of this study are that hospitalizations of children with PH account for an increasing proportion of all pediatric hospitalizations (1 in 1000 discharges at the beginning of the study period compared with 1 in 500 discharges by its end), with a dramatic increase in resource utilization associated with inpatient pediatric PH care, particularly from 2006 to the present," Dr Maxwell and colleagues write.

In an accompanying editorial, Steven H. Abman, MD, from the University of Colorado Denver Anschutz Medical Center and Children's Hospital Colorado, Aurora, and D. Dunbar Ivy, MD, also from the University of Colorado Denver Anschutz Medical Center and Children's Hospital Colorado, write that pediatric PH remains "understudied" and add that the work by Dr Maxwell and coauthors likely represents "the tip of the iceberg."

"The actual health care costs and resource needs of pediatric PH, as with other chronic diseases, are limited by a lack of data linking inpatient with outpatient care, in which frequent clinic appointments and diagnostic evaluations are essential for improving outcomes well beyond inpatient care alone," Dr Abman and Dr Ivy write. The editorialists advocate for PH experts to work with hospital leadership to craft "cost-sparing policies" for items such as medications.

Another unresolved area is true mortality trends for these children. Dr Maxwell and colleagues report a "steady improvement" in in-hospital mortality rates, with a decrease from 11.3% in January 1997 to 6.6% in December 2009. The commentators, however, caution that PH can be a " 'hidden' contributor" to morbidities.

"These results have practice and policy implications at the institutional, state, and national levels, particularly in the face of increasing pressure to restrain costs while caring for a population with increasingly complex medical needs," Dr Maxwell and coauthors conclude.

"Our finding that most children were not cared for in dedicated children's hospitals further underscores the need for increased awareness of PH among providers."

The study authors and the commentators have disclosed no relevant financial relationships.

Pediatrics. Published online July 6, 2015.

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