title: Comprehensive population-based determination of pediatric multiple sclerosis health care costs.
abstract: OBJECTIVE
  To determine the health care costs associated with pediatric multiple sclerosis (MS).
  
  
  METHODS
  We performed a retrospective analysis of all patients with MS 18 years of age or younger who were diagnosed or treated between 2002 and 2012 in a population-based cohort. Demographics and health care costs were extracted from the Intermountain Healthcare Enterprise Data Warehouse. Patients were divided into high-cost (>84th percentile) and low-cost groups and differences in health care utilization between the groups were analyzed.
  
  
  RESULTS
  Fifty-seven pediatric patients with MS were identified. Health care costs for the cohort totaled more than $1.5 million over the 10-year period, with the top 16th percentile of patients contributing nearly two-thirds. Outpatient visits represented the majority of health care encounters and expenditures, accounting for 83.1% of total costs. Costs per encounter were highest for inpatient stays, averaging $2,924 per stay.
  
  
  CONCLUSIONS
  The burden of health care expenses for pediatric patients with MS is significant. Expenditures related to outpatient visits were the largest contributor to costs, but inpatient stays were the most costly per encounter. A small proportion of patients incurred the bulk of costs and spent significantly more time receiving care compared to the majority of patients. Avoidance of inpatient treatment and efficient outpatient management are potential areas for health care cost reduction and improvement in care.
authors.affiliation: School of Medicine (M.A.W.), Study Design and Biostatistics Center (T.B.), Department of Biostatistics (T.B.), and Department of Pediatrics, Division of Pediatric Neurology (J.L.B., M.S.C.), University of Utah; and Intermountain Healthcare (E.K.K.), Salt Lake City.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Wright
authors.affiliation: School of Medicine (M.A.W.), Study Design and Biostatistics Center (T.B.), Department of Biostatistics (T.B.), and Department of Pediatrics, Division of Pediatric Neurology (J.L.B., M.S.C.), University of Utah; and Intermountain Healthcare (E.K.K.), Salt Lake City.
authors.forename: E Kent
authors.initials: EK
authors.lastname: Korgenski
authors.affiliation: School of Medicine (M.A.W.), Study Design and Biostatistics Center (T.B.), Department of Biostatistics (T.B.), and Department of Pediatrics, Division of Pediatric Neurology (J.L.B., M.S.C.), University of Utah; and Intermountain Healthcare (E.K.K.), Salt Lake City.
authors.forename: Tyler
authors.initials: T
authors.lastname: Bardsley
authors.affiliation: School of Medicine (M.A.W.), Study Design and Biostatistics Center (T.B.), Department of Biostatistics (T.B.), and Department of Pediatrics, Division of Pediatric Neurology (J.L.B., M.S.C.), University of Utah; and Intermountain Healthcare (E.K.K.), Salt Lake City.
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Bonkowsky
authors.affiliation: School of Medicine (M.A.W.), Study Design and Biostatistics Center (T.B.), Department of Biostatistics (T.B.), and Department of Pediatrics, Division of Pediatric Neurology (J.L.B., M.S.C.), University of Utah; and Intermountain Healthcare (E.K.K.), Salt Lake City.
authors.forename: Meghan S
authors.initials: MS
authors.lastname: Candee