714 - Estimating the Out of Pocket Costs to Families After Extreme Premature Delivery

Publication Number: 714.4835

Aashish V.. Shah, New York University Grossman School of Medicine, New York, NY, United States; Elena Wachtel, NYU Langone Health and Bellevue Hospital Center, New York, NY, United States

Background: Advancements in technology and improved outcomes in the neonatal intensive care unit has led to the ability to resuscitate premature infants up to 22 weeks gestational age. This has come at a time of rising healthcare costs, often with families having to pay out of pocket for a portion of the expenses. Currently, prenatal counseling does not include an estimate for what out-of-pocket costs of prematurity will be for a family, including direct medical, direct non-medical and indirect costs.

Objective: The objective of this study was to estimate the total costs associated with extreme prematurity that a family endures.

Design/Methods: This is a single center, cross sectional study with parental interviews which also included retrospective data collection on hospital billing. We collected billing data for infants born between 22.0 weeks and 28.6 weeks gestation between January 2017 and December 2021. Billing data consisted of hospital-based and neonatology faculty group practice billing at NYU Langone Health broken down by total billed, total collected from insurance and total collected from family. Parental interviews were done with families with child born between January 2022 and December 2023 between 22.0 weeks and 28.6 weeks gestation via telephone. Interview questions asked about direct medical costs, direct non-medical costs and indirect costs.

Results: Hospital billing data of 178 infants showed that the average extreme premature NICU hospitalization costs $598k, of which families on average pay $510 (Table 1). Excluding neonatal mortalities (death within 14 days), the average billed for NICU hospitalization is approximately $758k, of which families on average pay $533 (Table 2). If there was a neonatal mortality within 14 days, hospitals billed on average $56k of which families paid on average $141 (Table 3). Parental interviews (N=16) showed 100% of families paid nothing above their out-of-pocket maximums. The average weekly direct non-medical costs for families was $317. The average indirect costs associated with prolonged NICU hospitalization was $65,432, mainly from loss of pay from jobs.

Conclusion(s): The direct medical out-of-pocket costs for families for a premature NICU hospitalization did not exceed out-of-pocket maximums and often was fully paid by insurance. However, the costs associated with prolonged hospitalization are incurred by families through weekly expenses related to visiting the hospital and long-term effects affecting maternity / paternity leave and loss of job wages. NICUs can work with families to try and mitigate the direct non-medical costs and indirect costs.

Table 1
All premature births

Table 2
Premature births excluding mortalities before 14 days of life

Table 3
Premature birth mortalities before 14 days of life