Mallinckrodt Pharmaceuticals, Bedminster, NJ, 07921, USA.
HealthCore, Inc., An Independent Subsidiary of Anthem, Inc, Wilmington, DE, 19801, USA.
BMC Pediatr. 2019 Feb 11;19(1):53. doi: 10.1186/s12887-019-1414-x.
Prevalence of hemolytic neonatal hyperbilirubinemia (NHB) is not well characterized, and economic burden at the population level is poorly understood. This study evaluated the prevalence, clinical characteristics, and economic burden of hemolytic NHB newborns receiving treatment in U.S. real-world settings.
This cohort study used administrative claims from 01/01/2011 to 08/31/2017. The treated cohort had hemolytic NHB diagnosis and received phototherapy, intravenous immunoglobulin, and/or exchange transfusions. They were matched with non-NHB newborns who had neither NHB nor related treatments on the following: delivery hospital/area, gender, delivery route, estimated gestational age (GA), health plan eligibility, and closest date of birth within 5 years. Inferential statistics were reported.
The annual NHB prevalence was 29.6 to 31.7%; hemolytic NHB, 1.8 to 2.4%; treated hemolytic NHB, 0.46 to 0.55%, between 2011 and 2016. The matched analysis included 1373 pairs ≥35 weeks GA. The treated hemolytic NHB cohort had significantly more birth trauma and hemorrhage (4.5% vs. 2.4%, p = 0.003), vacuum extractor affecting newborn (1.9% vs. 0.8%, p = 0.014), and polycythemia neonatorum (0.8% vs. 0%, p = 0.001) than the matched non-NHB cohort. The treated hemolytic NHB cohort also had significantly longer mean birth hospital stays (4.5 vs. 3.0 days, p < 0.001), higher level 2-4 neonatal intensive care admissions (15.7% vs. 2.4, 15.9% vs. 2.8 and 10.6% vs. 2.5%, respectively, all p < 0.001) and higher 30-day readmission (8.7% vs. 1.7%, p < 0.001). One-month and one-year average total costs of care were significantly higher for the treated hemolytic NHB cohort vs. the matched non-NHB cohort, $14,405 vs. $5527 (p < 0.001) and $21,556 vs. $12,986 (p < 0.001), respectively. The average costs for 30-day readmission among newborns who readmitted were $13,593 for the treated hemolytic NHB cohort and $3638 for the matched non-NHB cohort, p < 0.001. The authors extrapolated GA-adjusted prevalence of treated hemolytic NHB in the U.S. newborn population ≥ 35 weeks GA and estimated an incremental healthcare expenditure of $177.0 million during the first month after birth in 2016.
The prevalence of treated hemolytic NHB was 4.6-5.5 patients per 1000 newborns. This high-risk hemolytic NHB imposed substantial burdens of healthcare resource utilization and incremental costs on newborns, their caregivers, and the healthcare system.
新生儿溶血性高胆红素血症（NHB）的流行情况尚未得到充分描述，其在人群层面的经济负担也未被充分了解。本研究评估了美国真实世界中接受治疗的溶血性 NHB 新生儿的患病率、临床特征和经济负担。
本队列研究使用了 2011 年 1 月 1 日至 2017 年 8 月 31 日的行政索赔数据。治疗组有溶血性 NHB 诊断，并接受了光疗、静脉注射免疫球蛋白和/或换血治疗。他们与未患有 NHB 或相关治疗的非 NHB 新生儿进行了匹配，匹配因素包括分娩医院/地区、性别、分娩方式、估计胎龄（GA）、健康计划资格和在 5 年内最接近的出生日期。报告了推理统计数据。
2011 年至 2016 年间，NHB 的年患病率为 29.6%至 31.7%；溶血性 NHB 为 1.8%至 2.4%；治疗性溶血性 NHB 为 0.46%至 0.55%。在 1373 对≥35 周 GA 的匹配分析中，治疗性溶血性 NHB 组新生儿出生创伤和出血的比例明显更高（4.5%比 2.4%，p=0.003），真空吸引器影响新生儿的比例也明显更高（1.9%比 0.8%，p=0.014），新生儿红细胞增多症的比例也明显更高（0.8%比 0%，p=0.001）。治疗性溶血性 NHB 组新生儿的平均出生住院时间也明显更长（4.5 比 3.0 天，p<0.001），2-4 级新生儿重症监护病房入院率也明显更高（15.7%比 2.4%，15.9%比 2.8%和 10.6%比 2.5%，均 p<0.001），30 天再入院率也明显更高（8.7%比 1.7%，p<0.001）。治疗性溶血性 NHB 组新生儿与匹配的非 NHB 组相比，1 个月和 1 年的平均总护理费用明显更高，分别为 14405 美元比 5527 美元（p<0.001）和 21556 美元比 12986 美元（p<0.001）。再入院新生儿的 30 天再入院费用，治疗性溶血性 NHB 组为 13593 美元，匹配的非 NHB 组为 3638 美元，p<0.001。作者推断了美国≥35 周 GA 新生儿人群中治疗性溶血性 NHB 的 GA 调整患病率，并估计 2016 年新生儿出生后第一个月的医疗保健增量支出为 1.770 亿美元。
治疗性溶血性 NHB 的患病率为每 1000 名新生儿中有 4.6-5.5 名患者。这种高危溶血性 NHB 给新生儿及其护理人员和医疗保健系统带来了大量的医疗资源利用和增量成本负担。
