The neonatal costs of maternal cocaine use.
OBJECTIVE
--To examine the added neonatal cost and length of hospital stay associated with fetal cocaine exposure.


METHODS
--All cocaine-exposed infants in the study population (n = 355) were compared with a random sample of unexposed infants (n = 199). Regression analysis was used to control for the independent effects of maternal age, smoking, alcohol consumption, prenatal care, race, gravidity, and sex of the infant.


METHODS
--A large, public, inner-city hospital studied from 1985 to 1986.


METHODS
--All infants were routinely tested for illicit substances, records were reviewed for maternal histories of substance abuse, and all known cocaine-exposed singleton infants were included.


METHODS
--Cost and length of stay until each infant was medically cleared for hospital discharge and cost and length of stay until each infant was actually discharged from the hospital.


RESULTS
--Neonatal hospital costs until medically cleared for discharge were $5200 more for cocaine-exposed infants than for unexposed infants (a difference of $7957 vs $2757 [P = .003]). The costs of infants remaining in the nursery while awaiting home and social evaluation or foster care placement increased this difference by more than $3500 (P less than .0001). Compared with other forms of cocaine, fetal exposure to crack was associated with much larger cost increases ($6735 vs $1226). Exposure to other illicit substances in addition to cocaine was also associated with much larger cost increases ($8450 vs $1283).


CONCLUSIONS
--At the national level, we estimate that these individual medical costs add up to about $500 million. The large magnitude of these costs indicates that effective treatment programs for maternal cocaine abusers could yield savings within their first year of operation.
Phibbs
C S
CS
Division of Health Policy and Management, Columbia University School of Public Health, New York, NY.
Bateman
D A
DA
Schwartz
R M
RM
D000328:Adult; D003042:Cocaine / Q000009:adverse effects*; D003361:Cost Allocation / Q000706:statistics & numerical data; D005260:Female; D005333:Fetus / Q000187:drug effects*; D006746:Hospital Bed Capacity, 500 and over; D006786:Hospitals, Urban / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000191:economics / Q000628:therapy; D007363:Intensive Care Units, Neonatal / Q000191:economics* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008423:Maternal Age; D008431:Maternal-Fetal Exchange; D009519:New York City; D011247:Pregnancy; D012044:Regression Analysis; D019966:Substance-Related Disorders / Q000150:complications*
D003042:Cocaine