Neonatal Abstinence Syndrome: Trend and Expenditure in Louisiana Medicaid, 2003-2013.
Objectives Determine trends in incidence and expenditure for perinatal drug exposure and neonatal abstinence syndrome (NAS) among Louisiana's Medicaid population. We also describe the maternal characteristics of NAS affected infants. Methods Retrospective cohort analysis using linked Medicaid and vital records data from 2003 to 2013. Conducted incidence and cost trends for drug exposed infants with and without NAS. Also performed comparison statistics among drug exposed infants with and without NAS and those not drug exposed. Results As rate of perinatal drug exposure increased, NAS rate per 1000 live Medicaid births also increased, from 2.1 (2003) to 3.6 (2007) to 8.0 (2013) (P for trend <0.0001). Total medical cost paid by Medicaid also increased from $1.3 million to $3.6 million to $8.7 million (P for trend <0.0001). Compared with drug exposed infants without NAS and those not drug exposed, infants with NAS were more likely to be white, have feeding difficulties, respiratory distress syndrome, sepsis, and seizures, all of which had an association at P < 0.0001. Over one-third (33.2%) of the mothers of infants with NAS had an opioid dependency in combination with a mental illness; with depression being most common. Conclusions for Practice Over an 11-year period, NAS rate among Louisiana's Medicaid infants quadrupled and the cost for caring for the affected infants increased six-fold. Medicaid, as the predominant payer for pregnant women and children affected by substance use disorders, must play a more active role in expanding access to comprehensive substance abuse treatment programs.
Medicaid Quality Management, Statistics and Reporting, Louisiana Department of Health and Hospitals, 628 North 4th Street, 7th Floor, Baton Rouge, LA, 70821, USA. eokoroh@cdc.gov.
Ekwutosi M
EM
Okoroh
Medicaid Quality Management, Statistics and Reporting, Louisiana Department of Health and Hospitals, 628 North 4th Street, 7th Floor, Baton Rouge, LA, 70821, USA.|Department of Obstetrics and Gynecology and School of Public Health, Louisiana State University, 2020 Gravier St Ste 3, New Orleans, LA, 70112, USA.
Rebekah E
RE
Gee
Medicaid Quality Management, Statistics and Reporting, Louisiana Department of Health and Hospitals, 628 North 4th Street, 7th Floor, Baton Rouge, LA, 70821, USA.
Baogong
B
Jiang
Louisiana Office of Public Health, Bureau of Family Health, 1450 Poydras St, New Orleans, LA, 70112, USA.
Melissa B
MB
McNeil
Medicaid Quality Management, Statistics and Reporting, Louisiana Department of Health and Hospitals, 628 North 4th Street, 7th Floor, Baton Rouge, LA, 70821, USA.
Beverly A
BA
Hardy-Decuir
Louisiana Office of Public Health, Bureau of Family Health, 1450 Poydras St, New Orleans, LA, 70112, USA.
Amy L
AL
Zapata
D000328:Adult; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D009035:Mothers / Q000706:statistics & numerical data*; D009357:Neonatal Abstinence Syndrome / Q000191:economics* / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D014481:United States
Expenditure; Mental illness; Neonatal abstinence syndrome; Prenatal drug exposure; Treatment programs