title: Costs, mortality, and hospital usage in relation to prenatal diagnosis in d-transposition of the great arteries.
abstract: BACKGROUND
  The impact of prenatal diagnosis of d-transposition of the great arteries (dTGA) on health-care usage is largely unknown. We evaluated a population-based cohort to assess costs, mortality and inpatient encounters by whether dTGA was prenatally diagnosed or not.
  
  
  METHODS
  The dTGA cases (born 1997-2011) identified at the Utah Birth Defect Network, which includes data on timing of diagnosis, were linked to statewide inpatient discharge data. We excluded preterm cases or cases with additional major heart defects. We evaluated hospitalizations and costs for infants (first year of life) and mothers (10 months before birth) using multivariable models adjusted for demographic and clinical risk factors.
  
  
  RESULTS
  Of 119 cases, 14 (12%) were prenatally diagnosed. Birth weight, surgical complexity and extracardiac defects/syndromes were similar between groups. Of 7 deaths (6%), two occurred pre-intervention in postnatally diagnosed infants. Prenatal diagnosis was associated with more in-hospital days (estimate 13 additional days, p = 0.03) and higher mean costs for mothers ($4,141 vs $12,148) and infants (90,419 vs $49,576). Prenatal diagnosis independently predicted higher adjusted costs for the overall cohort ($22,570, p = 0.045). After excluding deaths, total costs were no longer significantly different.
  
  
  CONCLUSIONS
  Mothers of prenatally diagnosed infants with dTGA had higher inpatient costs compared with those postnatally diagnosed. Costs trended higher for their infants, although were not significantly different. Linkage of population-based surveillance systems and outcome databases can be a powerful tool to further explore the complex relationship of prenatal diagnosis to costs and outcomes in other types of congenital heart diseases. Birth Defects Research 109:262-270, 2017. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
authors.forename: Nelangi M
authors.initials: NM
authors.lastname: Pinto
authors.affiliation: Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Richard
authors.initials: R
authors.lastname: Nelson
authors.affiliation: Division of Genetics, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
authors.forename: Lorenzo
authors.identifier: http://orcid.org/0000-0002-5322-7116
authors.initials: L
authors.lastname: Botto
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Puchalski
authors.affiliation: Division of Genetics, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
authors.forename: Sergey
authors.initials: S
authors.lastname: Krikov
authors.affiliation: Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Jaewhan
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Economics, University of Utah, Salt Lake City, Utah.
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Waitzman
mesh_terms: D000328:Adult; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000473:pathology; D014589:Utah
keywords: congenital heart disease; costs; prenatal diagnosis