Abstract
Background Esophageal atresia (EA) is a rare disease requiring surgical repair, usually within
the first days of life. Patients with EA require intensive postoperative care and
often have comorbidities. There is a lack of data on the costs incurred by patients
with EA during the first year of life.
Methods Anonymized claims data were provided by the Techniker Krankenkasse (∼10.8 million
clients). Data were extracted for patients who had an inpatient diagnosis of EA (International
Classification of Diseases [ICD]: Q39.0 or Q39.1) and a reconstruction of the esophageal
passage in case of atresia (Operationen-und Prozedurenschlüssel [German version of
ICPM, International Classification of Procedures in Medicine; OPS] 5–428.0 to 5–428.7,
5–316.1 or 5–431.0) during their first hospital stay. All patients were in their first
year of life at initial hospitalization (2016–2020) and were followed up for 1 year.
Costs, length of hospital stay, and duration of mechanical ventilation and differentiated
OPS services were analyzed using descriptive statistics. Multiple linear regression
was used to analyze the determinants of hospital costs.
Results A total of 119 patients with EA were included (55.5% male). The mean cost of the
1-year observation period was €89,736 ± 97,419 (range €12,755–640,154). The increasing
costs of the initial hospitalization led to a disproportionate increase in the costs
of the 1-year observation period. The presence of an associated malformation combined
with surgical complications was associated with almost five-fold higher costs than
in patients without an associated malformation and an uncomplicated course (€193,103 ± 157,507
vs. €39,846 ± 33,473). The mean duration of mechanical ventilation was 23.2 ± 43.1
days and the mean length of hospital stay was 80.3 ± 77.2 days.
Conclusion To our knowledge, this is the first study to investigate the costs of EA patients
in the first year of life. The presence of an associated malformation combined with
surgical complications was associated with almost five-fold higher costs than in patients
without an associated malformation and an uncomplicated course.
Keywords
esophageal atresia - economic - pediatric - congenital malformations - surgical complications
