Children with orofacial clefts: health-care use and costs among a privately insured population.

OBJECTIVES: Orofacial clefts are common birth defects that often require multiple surgeries and medical treatments during childhood. We used healthcare insurance claims data to estimate health-care expenditures for infants and children < or = 10 years of age with an orofacial cleft.
METHODS: The data were derived from the 2000-2004 MarketScan Commercial Claims and Encounters databases, which include person-specific information on health-care use, expenditures, and enrollment for approximately 50 large employers, health plans, and government and public organizations. Health insurance claims data from 821,619 children < or = 10 years of age enrolled in employer-sponsored plans during 2004 were analyzed. Expenditures for inpatient admissions, outpatient services, and prescription drug claims were calculated for children with and those without an orofacial cleft.
RESULTS: The difference in annual mean costs (i.e., incremental costs) between children aged 0 through 10 years with an orofacial cleft and those without an orofacial cleft was $13,405. The mean and median costs for children < or = 10 years of age with an orofacial cleft were eight times higher than for children of the same age without an orofacial cleft. Mean costs for infants with a cleft and another major, unrelated defect were 25 times higher than those for an infant without a cleft, and five times higher than for infants with an isolated cleft.
CONCLUSION: These findings document substantially elevated medical care costs for privately insured children with an orofacial cleft. Additional study of the economic burden associated with this condition should include a broader range of economic costs.