O1045: Contemporary Costs of Care for Children with Intestinal Failure

Background: Pediatric intestinal failure (PIF) occurs when the gastrointestinal tract cannot sustain normal growth and development. The advent of parenteral nutrition (PN) and multidisciplinary intestinal rehabilitation programs have reduced mortality, but treatment costs for this morbid condition remain understudied. This study examines the impact of requiring home PN on healthcare utilization and hospital costs during the first year following discharge after the initial birth admission in newborns with PIF.

Methods: A retrospective cohort study was conducted at a single quaternary care children’s hospital. We included patients < 18 years diagnosed with PIF (2018-2023) with at least 12 months of follow-up after birth hospitalization discharge. PIF was defined as the PN requirement for ≥60 out of 74 consecutive days. Hospital cost-accounting data and clinical information were collected for any emergency visit and readmission occurring within one year after index discharge. Costs (assessed from the hospital perspective) were adjusted to 2025 US dollars using the medical Consumer Price Index. We used a generalized linear model with negative binomial and log link, adjusting for sex, race/ethnicity, birth weight, and major comorbidities, to compare costs between PIF patients who required home PN and those who did not.

Results: A total of 78 infants met inclusion criteria, of which, 46% were male. Median gestational age and birth weight were 30 weeks (IQR 24-35) and 1,120 grams (IQR 720-2,340), respectively. Etiologies of PIF included necrotizing enterocolitis (40%), intestinal atresia (19%), gastroschisis (14%), volvulus (14%), and other conditions (13%). Forty-five percent of patients had at least one major comorbidity, and 27% required PN at discharge. On average, home PN patients were readmitted more frequently than those with no home PN (4.1 vs. 1.6; aRR=2.6; 95% CI, 1.2-5.1) and experienced more emergency visits (4.6 vs. 1.4; aRR=2.6; 95% CI, 1.3-5.5), Table 1). Total hospital days during readmissions were greater for Home PN patients compared to those without home PN (31.2 vs. 13.7 days; aRR=3.1; 95% CI, 1.5-6.4). The total costs for readmissions for Home PN patients compared to no home PN infants were $131,257 vs. $58,316 (aRR=3.4; 95% CI, 1.7-6.7) and for emergency visits, the costs were $ 4,148.35 vs. $1,069 (aRR=3.9; 95% CI, 2.1-7.3; Table 2). The combined mean costs for readmissions and emergency visits within the first year after birth discharge were $135,405 for home PN patients vs. $59,385 for no home PN patients (aRR 3.6, 95% CI, 1.8-6.9).

Conclusion: The need for home PN in infants with PIF is associated with more frequent emergency visits and readmissions, resulting in a 3.6-fold increase in hospital costs during the first year following discharge from birth admission. Interventions aimed at reducing the need for hospital utilization in this PIF population requiring home PN could substantially lower hospital costs post-discharge.