title: Intercenter Cost Variation for Perinatal Hypoxic-Ischemic Encephalopathy in the Era of Therapeutic Hypothermia.
abstract: To quantify intercenter cost variation for perinatal hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia across children's hospitals.
  
  
  
  Prospectively collected data from the Children's Hospitals Neonatal Database and Pediatric Health Information Systems were linked to evaluate intercenter cost variation in total hospitalization costs after adjusting for HIE severity, mortality, length of stay, use of extracorporeal support or nitric oxide, and ventilator days. Secondarily, costs for intensive care unit bed, electroencephalography (EEG), and laboratory and neuroimaging testing were also evaluated. Costs were contextualized by frequency of favorable (survival with normal magnetic resonance imaging) and adverse (death or need for gastric tube feedings at discharge) outcomes to identify centers with relative low costs and favorable outcomes.
  
  
  
  Of the 822 infants with HIE treated with therapeutic hypothermia at 19 regional neonatal intensive care units, 704 (86%) survived to discharge. The median cost/case for survivors was $58 552 (IQR $32 476-$130 203) and nonsurvivors $29 760 (IQR $16 897-$61 399). Adjusting for illness severity and select interventions, intercenter differences explained 29% of the variation in total hospitalization costs. The widest cost variability across centers was EEG use, although low cost and favorable outcome centers ranked higher with regards to EEG costs.
  
  
  
  There is marked intercenter cost variation associated with treating HIE across regional children's hospitals. Our investigation may help establish references for cost and enhance quality improvement and resource utilization projects related to HIE.
authors.affiliation: Children's National Health System and the Department of Pediatrics, George Washington University School of Medicine, Washington, DC. Electronic address: anguyenm@childrensnational.org.
authors.forename: An N
authors.initials: AN
authors.lastname: Massaro
authors.affiliation: Ann and Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Children's Hospitals Neonatal Consortium, Inc.
authors.forename: Karna
authors.initials: K
authors.lastname: Murthy
authors.affiliation: Children's Hospitals Association, Overland Park, KS.
authors.forename: Isabella
authors.initials: I
authors.lastname: Zaniletti
authors.affiliation: Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Noah
authors.initials: N
authors.lastname: Cook
authors.affiliation: Department of Pediatrics, University of Utah and the Primary Children's Medical Center, Salt Lake City, UT.
authors.forename: Robert
authors.initials: R
authors.lastname: DiGeronimo
authors.affiliation: Ann and Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Maria L V
authors.initials: ML
authors.lastname: Dizon
authors.affiliation: Department of Pediatrics and Children's Healthcare of Atlanta at Egleston, Emory University, Atlanta, GA.
authors.forename: Shannon E G
authors.initials: SE
authors.lastname: Hamrick
authors.affiliation: All Children's Hospital, St Petersburg, FL.
authors.forename: Victor J
authors.initials: VJ
authors.lastname: McKay
authors.affiliation: Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Girija
authors.initials: G
authors.lastname: Natarajan
authors.affiliation: Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Rao
authors.affiliation: Children's Hospitals Association, Overland Park, KS.
authors.forename: Troy
authors.initials: T
authors.lastname: Richardson
authors.affiliation: Children's Hospital of Colorado and Department of Pediatrics, University of Colorado, Aurora, CO.
authors.forename: Danielle
authors.initials: D
authors.lastname: Smith
authors.affiliation: Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO.
authors.forename: Amit M
authors.initials: AM
authors.lastname: Mathur
mesh_terms: D016208:Databases, Factual; D004569:Electroencephalography / Q000191:economics; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006776:Hospitals, Pediatric; D006801:Humans; D007036:Hypothermia, Induced / Q000191:economics*; D020925:Hypoxia-Ischemia, Brain / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000191:economics; D008297:Male; D059906:Neuroimaging / Q000191:economics; D010343:Patient Admission / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: cost; hypothermia; intercenter variation; neonatal intensive care unit; newborn