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. 2018 Apr;141(4):e20173520.
doi: 10.1542/peds.2017-3520.

Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004 - 2014

Tyler N A Winkelman  1   2 , Nicole Villapiano  3 , Katy B Kozhimannil  4 , Matthew M Davis  5   6 , Stephen W Patrick  7   8
Affiliations

Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004 - 2014

Tyler N A Winkelman et al. Pediatrics. 2018 Apr.

Abstract

Objectives: To describe incidence, health care use, and cost trends for infants with neonatal abstinence syndrome (NAS) who are covered by Medicaid compared with other infants.

Methods: We used 2004-2014 hospital birth data from the National Inpatient Sample, a nationally representative sample of hospital discharges in the United States (N = 13 102 793). Characteristics and trends among births impacted by NAS were examined by using univariate statistics and logistic regression.

Results: Medicaid covered 73.7% of NAS-related births in 2004 (95% confidence interval [CI], 68.9%-77.9%) and 82.0% of NAS-related births in 2014 (95% CI, 80.5%-83.5%). Among infants covered by Medicaid, NAS incidence increased more than fivefold during our study period, from 2.8 per 1000 births (95% CI, 2.1-3.6) in 2004 to 14.4 per 1000 births (95% CI, 12.9-15.8) in 2014. Infants with NAS who were covered by Medicaid were significantly more likely to be transferred to another hospital and have a longer length of stay than infants without NAS who were enrolled in Medicaid or infants with NAS who were covered by private insurance. Adjusting for inflation, total hospital costs for NAS births that were covered by Medicaid increased from $65.4 million in 2004 to $462 million in 2014. The proportion of neonatal hospital costs due to NAS increased from 1.6% in 2004 to 6.7% in 2014 among births that were covered by Medicaid.

Conclusions: The number of Medicaid-financed births that are impacted by NAS has risen substantially and totaled $462 million in hospital costs in 2014. Improving affordable health insurance coverage for low-income women before pregnancy would expand access to substance use disorder treatment and could reduce NAS-related morbidity and costs.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Incidence of NAS by primary payer.
FIGURE 2
FIGURE 2
Total hospital costs for NAS among infants who were enrolled in Medicaid.
FIGURE 3
FIGURE 3
Proportion of birth-related hospital costs due to NAS among infants who were enrolled in Medicaid.
See this image and copyright information in PMC

References

    1. Patrick SW, Davis MM, Lehman CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol. 2015;35(8):667. - PubMed
    1. Ko JY, Patrick SW, Tong VT, Patel R, Lind JN, Barfield WD. Incidence of neonatal abstinence syndrome - 28 states, 1999-2013. MMWR Morb Mortal Wkly Rep. 2016;65(31):799–802 - PubMed
    1. Villapiano NLG, Winkelman TNA, Kozhimannil KB, Davis MM, Patrick SW. Rural and urban differences in neonatal abstinence syndrome and maternal opioid use, 2004 to 2013. JAMA Pediatr. 2017;171(2):194–196 - PubMed
    1. McQueen K, Murphy-Oikonen J. Neonatal abstinence syndrome. N Engl J Med. 2016;375(25):2468–2479 - PubMed
    1. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA. 2012;307(18):1934–1940 - PubMed

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