Inpatient Hospitalization Costs Associated With Birth Defects Among Persons of all Ages — United States, 2013

Annelise C. Arth, MPH; Sarah C. Tinker, PhD; Regina M. Simeone, MPH; Elizabeth C. Ailes, PhD; Janet D. Cragan, MD; Scott D. Grosse, PhD


Morbidity and Mortality Weekly Report. 2017;66(2):41-46. 

In This Article


CDC's analysis of NIS data indicates that the annual cost of hospitalizations that included a birth defect discharge diagnosis code in 2013 was $22.9 billion. Although birth defect–associated hospitalizations accounted for 3.0% of all hospitalizations, they accounted for 5.2% of total hospital costs, highlighting the disproportionately high costs of treating patients with these conditions. The share of costs was especially high for infants, accounting for 35.0% of total hospitalization costs for children aged <1 year. Across all ages, costs were particularly high for hospitalizations associated with cardiovascular defects, which accounted for approximately 14.0% of birth defect–associated hospitalizations but 26.6% of birth defect–associated costs.

In a previous analysis of 2004 HCUP data, the total cost of birth defect–associated hospitalizations was estimated at $2.6 billion.[7] This estimate was based only on primary ICD-9-CM discharge diagnosis codes. Inclusion of only primary diagnosis codes in this analysis resulted in an estimate of $5.0 billion. However, estimates based only on the primary ICD-9-CM codes are likely to be an underestimate of costs, because birth is often coded as the principal diagnosis for birth hospitalizations,[8] and because birth defects might be important factors contributing to hospitalizations associated with other primary diagnosis codes.

The findings in this report are subject to at least five limitations. First, use of all diagnosis codes might have overestimated costs because the coded birth defect might have been incidental to the reason for the hospitalization. Conversely, birth defects that influence conditions leading to hospitalization might be less likely to be coded as a person ages. Second, the primary analysis included preterm infants, who have higher associated hospitalization costs,[9] potentially leading to an overestimate of cost. Although preterm birth is more common in infants with birth defects,[10] the extent to which hospitalization costs are attributable to preterm birth, rather than the birth defect, cannot be estimated with these data. Third, some children had more than one birth defect diagnosis; attributing the cost of hospitalization to each defect independently in these children might have resulted in an overestimate of the cost of one or more of the individual defects. Fourth, although NIS data are routinely used for research, their source data were originally created for billing purposes and diagnoses are not validated, which might have led to an over- or underestimate of average costs. Finally, the cost-to-charge ratios used in this analysis were based on aggregated hospital data and were not specific to the departments or treatments more likely to be used for birth defect hospitalization, which might have affected the cost estimate in either direction.

By estimating the cost of birth defect–associated hospitalizations, both researchers and policy makers can be more informed of the impact of birth defects on the health care system and can use this knowledge to motivate change through prevention, early detection, and care throughout the lifespan of affected persons.