Spina bifida (SB) is a birth defect in which the spinal column does not form properly and the spinal nerves may protrude through an opening present in the back of the child. Some direct and indirect costs per year are given in table-1 .
Treatment plans for Spina Bifida and their cost
A patient with SB can be treated by different ways or plans. These ways of treatment depend upon the age of the patients, severity of the disease and also on the economic conditions of patients or their families. Spina Bifida treatment costs (for both inpatient and outpatient) is much higher in childhood as compared to other population groups and adult patients with spina bifida. Different treatment plans for children and adults with spina bifida and their total costs are mentioned in table-2 [5,6].
1. Surgery to repair the spine
Surgery to repair the spine should be performed within the first 48 hours of the child’s birth. In this procedure the surgeon places the spinal nerves and other protrusions back into the child’s body. Any space in the vertebrae is closed and covered with muscles and skin layers. A significant part of total cost occurs for this very procedure. Spina bifida treatment costs at birth for such surgery is about $13 million per year in United States. This procedure is safest and less problematic at this age. Further surgery may be needed if some problem with bone formation and growth (scoliosis) occurs and it may add to the cost.
2. Treating Hydrocephalus
If the child has hydrocephalus (a build up of cerebrospinal fluid CSF in the brain), he/she should be treated by surgery. In this surgery, the surgeon places a slim tube called as a shunt. This shunt drains CSF from the brain to another part of the body, usually the abdomen. The treatment cost for this procedure is $15.5 million per year in the US. This cost was higher in 2003-4, which was about $20-22 million per year. Some complications such as blockage of the tube and infections may occur with this type of procedure and can increase costs.
Physiotherapy is the most useful procedure to manage the child’s condition for an independent life. Physiotherapy in patients of SB does not cost too much and annual cost of this procedure is not more than $3-4 million.
4. Occupational therapy
The goal of this procedure is to help the child develop skills associated with daily living activities. An occupational therapist identifies the problem of the patient occurring in his/her routine life (such as problems in dressing) and provides certain skill training or equipment to avoid this difficulty. This method of treatment costs very little.
5. Medical treatment
The annual direct medical cost of treatment in SB is lower as compared to the surgical procedures but is not minimal. The annual cost was $11,066 per patient in 1993 and $65,177 per patient in 2003 in the US [2,3]. A large proportion of medically treated patients were adults above 14 years. Only Washington State spent 2.1 million dollars on the medical treatment of spina bifida in 1993. This figure is 11.6 times higher (medically and surgically) in children . However, the cost varies from age to age such as $34,013 (age 0-1 year), 14,930 (age 2-4 years), $13,220 (age 5-17 years) and $4,194 (age +18 years). Some direct and indirect costs per patient based on distribution by age are given in table-3 [5,6].
6. Treatment cost for Secondary conditions due to spina bifida
A large number of admissions to hospitals for adults due to secondary conditions (urological infections, renal stones, pressure ulcers) were associated with spina bifida and the cost of these co-morbidities was significantly high . The annual medical cost per patient for the treatment of these conditions was round about 3,000 dollars .
7. Stem Cell Treatment.
Here is an article about stem cell treatment for SB.
In conclusion, the average lifetime cost of caring for a patient with SB is more than $635 000.. However, it may be as high as $1,000,000 for some families.
- Robbins JM, Bird TM, Tilford JM, et al. Hospital stays, hospital charges, and in-hospital deaths among infants with selected birth defects: United States, 2003. MMWR. 2007;56(2):25-9.
- Ireys HT, Anderson GF, Shaffer TJ, Neff JM. Expenditures for care of children with chronic illnesses enrolled in the Washington State Medicaid program, fiscal year 1993. Pediatrics. 1997;100:197-204.
- Ouyang LJ, Grosse SD, Armour BS, Waitzman NJ. Health care expenditures of children and adults with spina bifida in a privately insured US population. Birth Defects Res A Clin Mol Teratol. 2007;79:552-8.
- Kinsman SL, Doehring MC. The cost of preventable conditions in adults with spina bifida. Eur J Pediatr Surg. 1996;6:17-20.
- Drummond M. Cost-of-illness studies: a major headache? Pharmacoeconomics. 1992;2(1):1– 4.
- Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the Economic Evaluation of Health Care Programmes, 3rd ed. New York, NY: Oxford University Press; 2006.
- Waitzman N, Romano P, Grosse S. The Halflife of Cost-of-Illness Estimates: The Case of Spina Bifida. Salt Lake City, UT: Department of Economics, University of Utah; 2004.Working Paper Series