Hospital use and associated costs of children aged zero-to-two years with craniofacial malformations in Massachusetts

BACKGROUND: Craniofacial malformations (CFMs) are among the most common and correctable birth defects in the United States, often requiring multiple medical and surgical treatments. However, population-based data on hospital utilization and costs are sparse. METHODS: This retrospective cohort study used linked data from the Massachusetts Pregnancy to Early Life Longitudinal Data System. Cases were children born during 1998-2002 in Massachusetts hospitals to Massachusetts residents, alive at age two years, and ascertained by the Massachusetts Birth Defects Monitoring Program as having a CFM (orofacial cleft, craniosynostosis, microtia/anotia). Mean and median number of inpatient days and hospital facility costs (excluding professional fees) during birth and postbirth hospitalizations to age two years are presented by defect type and pattern for cases and compared to Massachusetts children without CFMs. RESULTS: Children with CFMs (N = 649) mostly had orofacial clefts (73%), and 73% had no other major birth defect. Both mean (12.0) and median (6) number of inpatient days from birth to age two years among children with CFMs were three times higher than among all other children. Mean incremental hospital cost of children who survived to age two years with CFMs compared to those with no CFM was $4,901 more during the birth hospitalization and $12,858 more for postbirth hospitalizations, or $17,760 overall. CONCLUSION: In the first two years of life, children with CFMs incur increased hospital costs compared to other children without such conditions, with substantial heterogeneity by defect and pattern type.