Publications by authors named "Scott D Grosse"

219 Publications

Venlafaxine prescription claims among insured women of reproductive age and pregnant women, 2011-2016.

Birth Defects Res 2021 Apr 16. Epub 2021 Apr 16.

Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Background: Some studies have reported associations between prenatal use of venlafaxine, a serotonin-norepinephrine reuptake inhibitor used for depressive and anxiety disorders, and some birth defects. We described the prevalence of venlafaxine prescription claims among privately insured women of reproductive age and pregnant women.

Methods: Venlafaxine prescription claims were examined using the IBM MarketScan Commercial Databases. We included women of reproductive age (15-44 years) who had ≤45 days of lapsed enrollment during the calendar year of interest (2011-2016) in a non-capitated healthcare plan sponsored by a large, self-insured employer with prescription drug coverage and no mental health service carve-out. Annual cohorts of pregnant women were identified among eligible women of reproductive age via pregnancy diagnosis and procedure codes. Venlafaxine prescriptions were identified via National Drug Codes in outpatient pharmacy claims and we estimated the annual proportion of women with venlafaxine claims by pregnancy trimester (pregnant women only), age, and Census division.

Results: Each year during 2011-2016, approximately 1.2% of eligible reproductive-aged and 0.3% of eligible pregnant women filled a venlafaxine prescription. Among pregnant women, the proportion with venlafaxine claims was highest during the first trimester and decreased during the second and third trimesters. Small temporal increases in venlafaxine claims were observed for reproductive-aged and pregnant women, with the largest among women aged 15-19 years.

Conclusions: Venlafaxine prescription claims were low among women of reproductive age and pregnant women during 2011-2016, with some increasing use over time among women aged 15-19 years.
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http://dx.doi.org/10.1002/bdr2.1897DOI Listing
April 2021

State-Level Health Care Expenditures Associated With Disability.

Public Health Rep 2021 Mar 5:33354920979807. Epub 2021 Mar 5.

1242 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Objective: Given the growth in national disability-associated health care expenditures (DAHE) and the changes in health insurance-specific DAHE distribution, updated estimates of state-level DAHE are needed. The objective of this study was to update state-level estimates of DAHE.

Methods: We combined data from the 2013-2015 Medical Expenditure Panel Survey, 2013-2015 Behavioral Risk Factor Surveillance System, and 2014 National Health Expenditure Accounts to calculate state-level DAHE for US adults in total, per adult, and per (adult) person with disability (PWD). We adjusted expenditures to 2017 prices and assessed changes in DAHE from 2003 to 2015.

Results: In 2015, DAHE were $868 billion nationally (range, $1.4 billion in Wyoming to $102.8 billion in California) accounting for 36% of total health care expenditures (range, 29%-41%). From 2003 to 2015, total DAHE increased by 65% (range, 35%-125%). In 2015, DAHE per PWD were highest in the District of Columbia ($27 839) and lowest in Alabama ($12 603). From 2003 to 2015, per-PWD DAHE increased by 13% (range, -20% to 61%) and per-capita DAHE increased by 28% (range, 7%-84%). In 2015, Medicare DAHE per PWD ranged from $10 067 in Alaska to $18 768 in New Jersey. Medicaid DAHE per PWD ranged from $9825 in Nevada to $43 365 in the District of Columbia. Nonpublic-health insurer per-PWD DAHE ranged from $7641 in Arkansas to $18 796 in Alaska.

Conclusion: DAHE are substantial and vary by state. The public sector largely supports the health care costs of people with disabilities. State policy makers and other stakeholders can use these results to inform the development of public health programs that support and provide ongoing health care to people with disabilities.
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http://dx.doi.org/10.1177/0033354920979807DOI Listing
March 2021

Identification of congenital CMV cases in administrative databases and implications for monitoring prevalence, healthcare utilization, and costs.

Curr Med Res Opin 2021 Mar 4:1-23. Epub 2021 Mar 4.

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Objective: To critically review researchers' use of diagnosis codes to identify congenital cytomegalovirus (cCMV) infection or disease in healthcare administrative databases. Understanding the limitations of cCMV ascertainment in those databases can inform cCMV surveillance and health services research.

Methods: We identified published studies that used diagnosis codes for cCMV or CMV in hospital discharge or health insurance claims and encounters records for infants to assess prevalence, use of services, or healthcare costs. We reviewed estimates of prevalence and of charges, costs, or expenditures associated with cCMV diagnosis codes.

Results: Five studies assessed hospitalizations with cCMV diagnosis codes recorded in hospital discharge databases, from the United States ( = 3), Australia ( = 1), and the United Kingdom ( = 1). Six other studies analyzed claims or encounters data from the United States ( = 5) or Japan ( = 1) to identify infants with cCMV codes. Prevalence estimates of recognized cCMV ranged from 0.6 to 3.8 per 10,000 infants. Economic analyses reported a wide range of per-hospitalization or per-infant cost estimates, which lacked standardization or comparability.

Conclusions: The administrative prevalence of cCMV cases reported in published analyses of administrative data from North America, Western Europe, Japan, and Australia (0.6-3.8 per 10,000 infants) is an order of magnitude lower than the estimates of the true birth prevalence of 3-7 per 1,000 newborns based on universal newborn screening pilot studies conducted in the same regions. Nonetheless, in the absence of systematic surveillance for cCMV, administrative data might be useful for assessing trends in testing and clinical diagnosis. To the extent that cCMV cases recorded in administrative databases are not representative of the full spectrum of cCMV infection or disease, per-child cost estimates generated from those data may not be generalizable. On the other hand, claims data may be useful for estimating patterns of healthcare use and expenditures associated with combinations of diagnoses for cCMV and known complications of cCMV.
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http://dx.doi.org/10.1080/03007995.2021.1890556DOI Listing
March 2021

Economic assessments of the burden of congenital cytomegalovirus infection and the cost-effectiveness of prevention strategies.

Semin Perinatol 2021 Jan 23:151393. Epub 2021 Jan 23.

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Objective: This is a critical review of published economic analyses on congenital cytomegalovirus infection and strategies for its detection and prevention.

Findings: The review identified four cost-of-illness studies and nine cost-effectiveness analyses: three of vaccination of young women, two of prenatal screening, and four of newborn screening. All reported either large economic costs or favorable cost-effectiveness of interventions. However, sensitivity analyses did not address some of the most critical assumptions.

Conclusions: Reviewed economic analyses overattributed certain adverse long-term outcomes to congenital cytomegalovirus infection, while other long-term costs were not included. Overall, limited conceptual frameworks, unrepresentative data sources, and unsupported or inadequately documented assumptions regarding outcomes and costs hinder the ability of policymakers to draw conclusions. A major challenge is the limited information on long-term outcomes and costs for representative cohorts of individuals with congenital cytomegalovirus, which further research could helpfully address.
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http://dx.doi.org/10.1016/j.semperi.2021.151393DOI Listing
January 2021

Preterm birth lifetime costs in the United States in 2016: An update.

Semin Perinatol 2021 Jan 24:151390. Epub 2021 Jan 24.

Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA.

The societal cost of preterm birth indicates potential economic gains from interventions that reduce the incidence of preterm birth. Changes in the epidemiology of preterm birth and healthcare costs require periodic updates to cost estimates. Previously reported incremental cost estimates for the United States in 2004 were updated. The discounted present value of the excess cost associated with prematurity for the 2016 US birth cohort was estimated to be $25.2 billion: $17.1 billion for medical care of persons born preterm, $2.0 billion for delivery care, $1.3 billion for early intervention and special education, and $4.8 billion in lost productivity due to associated disabilities in adults. The nominal and inflation-adjusted incremental costs per preterm birth increased by 26% and 4%, respectively, during 2004-2016. The aggregate cost decreased by 4%, associated with declines in overall births and the preterm birth rate and changes in the distribution by gestational age.
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http://dx.doi.org/10.1016/j.semperi.2021.151390DOI Listing
January 2021

Medical expenditures for hypertensive disorders during pregnancy that resulted in a live birth among privately insured women.

Pregnancy Hypertens 2021 Mar 15;23:155-162. Epub 2020 Dec 15.

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.

Objective: To estimate the excess maternal health services utilization and direct maternal medical expenditures associated with hypertensive disorders during pregnancy and one year postpartum among women with private insurance in the United States.

Study Design: We used 2008-2014 IBM MarketScan® Commercial Databases to identify women aged 15-44 who had a pregnancy resulting in live birth during 1/1/09-12/31/13 and were continuously enrolled with non-capitated or partially capitated coverage from 12 months before pregnancy through 12 months after delivery. Hypertensive disorders identified by diagnosis codes were categorized into three mutually exclusive types: preeclampsia and eclampsia, chronic hypertension, and gestational hypertension. Multivariate negative binomial and generalized linear models were used to estimate service utilization and expenditures, respectively.

Main Outcome Measures: Per person excess health services utilization and medical expenditures during pregnancy and one year postpartum associated with hypertensive disorders (in 2014 US dollars).

Results: Women with preeclampsia and eclampsia, chronic hypertension, and gestational hypertension had $9,389, $6,041, and $2,237 higher mean medical expenditures compared to women without hypertensive disorders ($20,252), respectively (ps < 0.001). One-third (36%) of excess expenditure associated with hypertensive disorders during pregnancy was attributable to outpatient services.

Conclusions: Hypertensive disorders during pregnancy were associated with significantly higher health services utilization and medical expenditures among privately insured women with hypertensive disorders. Medical expenditures varied by types of hypertensive disorders. Stakeholders can use this information to assess the potential economic benefits of interventions that prevent these conditions or their complications.
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http://dx.doi.org/10.1016/j.preghy.2020.12.002DOI Listing
March 2021

Health and economic outcomes of newborn screening for infantile-onset Pompe disease.

Genet Med 2021 Apr 7;23(4):758-766. Epub 2020 Dec 7.

Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.

Purpose: To estimate health and economic outcomes associated with newborn screening (NBS) for infantile-onset Pompe disease in the United States.

Methods: A decision analytic microsimulation model simulated health and economic outcomes of a birth cohort of 4 million children in the United States. Universal NBS and treatment was compared with clinical identification and treatment of infantile-onset Pompe disease. Main outcomes were projected cases identified, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) over the life course.

Results: Universal NBS for Pompe disease and confirmatory testing was estimated to cost an additional $26 million annually. Additional medication costs associated with earlier treatment initiation were $181 million; however, $8 million in medical care costs for other services were averted due to delayed disease progression. Infants with screened and treated infantile-onset Pompe disease experienced an average lifetime increase of 11.66 QALYs compared with clinical detection. The ICER was $379,000/QALY from a societal perspective and $408,000/QALY from the health-care perspective. Results were sensitive to the cost of enzyme replacement therapy.

Conclusion: Newborn screening for Pompe disease results in substantial health gains for individuals with infantile-onset Pompe disease, but with additional costs.
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http://dx.doi.org/10.1038/s41436-020-01038-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035228PMC
April 2021

Challenges in Assessing the Cost-Effectiveness of Newborn Screening: The Example of Congenital Adrenal Hyperplasia.

Int J Neonatal Screen 2020 Oct 25;6(4). Epub 2020 Oct 25.

Endocrinology Service and Research Center of the Sainte-Justine Hospital and Department of Pediatrics, University of Montreal, Montreal, QC H3T 1C5, Canada.

Generalizing about the cost-effectiveness of newborn screening (NBS) is difficult due to the heterogeneity of disorders included in NBS panels, along with data limitations. Furthermore, it is unclear to what extent evidence about cost-effectiveness should influence decisions to screen for specific disorders. Screening newborns for congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency can serve as a useful test case, since there is no global consensus on whether CAH should be part of NBS panels. Published and unpublished cost-effectiveness analyses of CAH screening have yielded mixed findings, largely due to differences in methods and data sources for estimating health outcomes and associated costs of early versus late diagnosis as well as between-country differences. Understanding these methodological challenges can help inform future analyses and could also help interested policymakers interpret the results of economic evaluations.
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http://dx.doi.org/10.3390/ijns6040082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712219PMC
October 2020

Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents With Congenital Adrenal Hyperplasia.

J Endocr Soc 2020 Dec 14;4(12):bvaa152. Epub 2020 Oct 14.

Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.

Background: Little is known regarding risk for co-occurring mental health conditions among pediatric patients with congenital adrenal hyperplasia (CAH). The objective of the current study was to investigate the prevalence of medically managed attention-deficit/hyperactivity disorder (ADHD) in 2 large administrative samples of insured children and adolescents with and without CAH in the United States.

Methods: We assessed the prevalence of CAH and of medically managed ADHD using algorithms defined from diagnosis codes and filled prescriptions data using the IBM MarketScan Commercial and Multi-State Medicaid claims databases. We evaluated subjects who were continuously enrolled for ≥ 12 months with a first claim during October 2015 through December 2017 when they were 5 to 18 years old.

Results: The administrative prevalence of CAH in the Commercial (N = 3 685 127) and Medicaid (N = 3 434 472) samples was 10.1 per 100 000 (n = 372) and 7.2 per 100 000 (n = 247), respectively. The prevalence of medically managed ADHD in the non-CAH population was 8.4% in the Commercial sample and 15.1% in the Medicaid sample. Among children with CAH, there was no increased prevalence of ADHD in the Commercial (9.2%, prevalence ratio [PR] = 1.1; 95% confidence interval [CI], 0.82-1.54; = 0.48) or Medicaid (13.8%; PR = 0.91; 95% CI, 0.67-1.24; = 0.55) samples compared with the general population.

Conclusions: Using 2 large samples of insured children and adolescents in the United States, we found similar prevalence of medically managed ADHD among those with CAH and the general population. Future research to assess the validity of our claims algorithm for identifying pediatric CAH cases is warranted.
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http://dx.doi.org/10.1210/jendso/bvaa152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648384PMC
December 2020

Healthcare Costs of Pediatric Autism Spectrum Disorder in the United States, 2003-2015.

J Autism Dev Disord 2020 Oct 28. Epub 2020 Oct 28.

Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.

Published healthcare cost estimates for children with autism spectrum disorder (ASD) vary widely. One possible contributor is different methods of case ascertainment. In this study, ASD case status was determined using two sources of parent reports among 45,944 children ages 3-17 years in the Medical Expenditure Panel Survey (MEPS) linked to the National Health Interview Survey (NHIS) Sample Child Core questionnaire. In a two-part regression model, the incremental annual per-child cost of ASD relative to no ASD diagnosis was $3930 (2018 US dollars) using ASD case status from the NHIS Child Core and $5621 using current-year ASD case status from MEPS. Both estimates are lower than some published estimates but still represent substantial costs to the US healthcare system.
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http://dx.doi.org/10.1007/s10803-020-04704-zDOI Listing
October 2020

Spending on Young Children With Autism Spectrum Disorder in Employer-Sponsored Plans, 2011-2017.

Psychiatr Serv 2021 01 20;72(1):16-22. Epub 2020 Oct 20.

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Grosse, Nichols, Yeargin-Allsopp); Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (Ji); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Rice). This work was performed when Dr. Ji was a Prevention Effectiveness Fellow at the CDC.

Objective: Rapid increases in the prevalence of autism spectrum disorder (ASD) and increased access to intensive behavioral interventions have likely increased health care spending. This study estimated recent changes in spending among privately insured children with and without current ASD.

Methods: A repeated cross-sections analysis of 2011-2017 claims data from large-employer-sponsored health plans assessed changes in annual expenditures by service type for children ages 3-7 enrolled for ≥1 year and with two or more claims with ASD billing codes within a calendar year and for all other children.

Results: Mean spending per child with a current-year ASD diagnosis increased by 51% in 2017 U.S. dollars, from roughly $13,000 in 2011 to $20,000 in 2017. Among children who did not meet the current-year ASD case definition, per-child spending increased by 8%. Spending on children with ASD accounted for 41% of spending growth for children ages 3-7 during 2011-2017. Outpatient behavioral intervention-related spending per child with ASD increased by 376%, from $1,746 in 2011 to $8,317 in 2017; spending on all other services increased by 2%. Their share of behavioral intervention-related spending increased from 13.2% in 2011 to 41.7% in 2017. In 2011, 2.5% of children with current-year ASD diagnoses incurred ≥$20,000 in outpatient behavioral intervention-related spending, which increased to 14.4% in 2017.

Conclusions: During 2011-2017, spending increased six times as much for privately insured children ages 3-7 with current-year ASD as for children without ASD, largely from increased behavioral intervention-related spending. One in seven children received at least $20,000 in services in 2017.
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http://dx.doi.org/10.1176/appi.ps.202000099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879423PMC
January 2021

Preventing Breast, Cervical, and Colorectal Cancer Deaths: Assessing the Impact of Increased Screening.

Prev Chronic Dis 2020 10 8;17:E123. Epub 2020 Oct 8.

Office of the Associate Director for Science, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: The US Preventive Services Task Force (USPSTF) recommends select preventive clinical services, including cancer screening. However, screening for cancers remains underutilized in the United States. The Centers for Disease Control and Prevention leads initiatives to increase breast, cervical, and colorectal cancer (CRC) screening. We assessed the number of avoidable deaths from increased screening, according to USPSTF recommendations, for CRC and female breast and cervical cancers.

Methods: We used model-based estimates of avoidable deaths for the lifetime of single-year age cohorts under the current and increased use of screening scenarios (data year 2016; analysis, 2018). We calculated prevented cancer deaths for each 1% increase in screening uptake and extrapolated to current level of screening (2016), current level plus 10 percentage points, and increasing screening to 90% and 100% of the eligible population.

Results: Increased use of screening from current levels to 100% would prevent an additional 2,821 deaths from breast cancer, 6,834 deaths from cervical cancer, and 35,530 deaths from CRC over a lifetime of the respective single-year cohort. Increasing use of CRC screening would prevent approximately 8.5 times as many deaths as the equivalent increase in use of breast cancer screening (women only), although twice as many people (men and women) would have to be screened for CRC.

Conclusions: A large number of deaths could be avoided by increasing breast, cervical, and CRC screening. Public health programs incorporating strategies shown to be effective can help increase screening rates.
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http://dx.doi.org/10.5888/pcd17.200039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553223PMC
October 2020

Changes in Provider Type and Prescription Refills Among Privately Insured Children and Youth With ADHD.

J Atten Disord 2020 Sep 18:1087054720956727. Epub 2020 Sep 18.

Nationwide Children's Hospital, Columbus, OH, USA.

Objective: The aim of this paper is to understand associations between age and health care provider type in medication continuation among transition-aged youth with ADHD.

Method: Using an employer-sponsored insurance claims database, we identified patients with likely ADHD and receipt of ADHD medications. Among patients who had an outpatient physician visit at baseline and maintained enrollment at follow-up 3 years later, we evaluated which ones continued to fill prescriptions for ADHD medications.

Results: Patients who were younger at follow-up more frequently continued medication (77% of 11-12 year-olds vs. 52% of 19-20 year-olds). Those who saw a pediatric provider at baseline and follow-up more frequently continued to fill ADHD medication prescriptions than those who saw a pediatric provider at baseline and non-pediatric providers at follow-up (71% vs. 53% among those ages 15-16 years at follow-up).

Conclusion: Adolescents and young adults with ADHD who changed from pediatric to exclusively non-pediatric providers less frequently continued to receive ADHD medications.
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http://dx.doi.org/10.1177/1087054720956727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969464PMC
September 2020

Administrative data identify sickle cell disease: A critical review of approaches in U.S. health services research.

Pediatr Blood Cancer 2020 12 17;67(12):e28703. Epub 2020 Sep 17.

Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan.

To identify people living with sickle cell disease (SCD) and study their healthcare utilization, researchers can either use clinical records linked to administrative data or use billing diagnosis codes in stand-alone administrative databases. Correct identification of individuals clinically managed for SCD using diagnosis codes in claims databases is limited by the accuracy of billing codes in outpatient encounters. In this critical review, we assess the strengths and limitations of claims-based SCD case-finding algorithms in stand-alone administrative databases that contain both inpatient and outpatient records. Validation studies conducted using clinical records and newborn screening for confirmation of SCD case status have found that algorithms that require three or more nonpharmacy claims or one inpatient claim plus two or more outpatient claims with SCD codes show acceptable accuracy (positive predictive value and sensitivity) in children and adolescents. Future studies might seek to assess the accuracy of case-finding algorithms over the lifespan.
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http://dx.doi.org/10.1002/pbc.28703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606824PMC
December 2020

Infants with Congenital Disorders Identified Through Newborn Screening - United States, 2015-2017.

MMWR Morb Mortal Wkly Rep 2020 Sep 11;69(36):1265-1268. Epub 2020 Sep 11.

Newborn screening (NBS) identifies infants at risk for congenital disorders for which early intervention has been shown to improve outcomes (1). State public health programs are encouraged to screen for disorders on the national Recommended Uniform Screening Panel (RUSP), which increased from 29 disorders in 2005 to 35 in 2018.* The RUSP includes hearing loss (HL) and critical congenital heart defects, which can be detected through point-of-care screening, and 33 disorders detected through laboratory screening of dried blood spot (DBS) specimens. Numbers of cases for 33 disorders on the RUSP (32 DBS disorders and HL) reported by 50 U.S. state programs were tabulated. The three subtypes of sickle cell disease (SCD) listed as separate disorders on the RUSP (S,S disease; S,beta-thalassemia; and S,C disease) were combined for the current analysis, and the frequencies of the resulting disorders were calculated relative to annual births. During 2015-2017, the overall prevalence was 34.0 per 10,000 live births. Applying that frequency to 3,791,712 live births in 2018, approximately 12,900 infants are expected to be identified each year with one of the disorders included in the study. The most prevalent disorder is HL (16.5 per 10,000), and the most prevalent DBS disorders are primary congenital hypothyroidism (CH) (6.0 per 10,000), SCD (4.9 per 10,000), and cystic fibrosis (CF) (1.8 per 10,000). Notable changes in prevalence for each of these disorders have occurred since the previous estimates based on 2006 births (2). The number of infants identified at a national level highlights the effect that NBS programs are having on infant health through early detection, intervention, and potential improved health, regardless of geographic, racial/ethnic, or socioeconomic differences.
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http://dx.doi.org/10.15585/mmwr.mm6936a6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499833PMC
September 2020

Association of smoke-free laws with preterm or low birth weight deliveries-A multistate analysis.

Health Serv Res 2021 Feb 2;56(1):61-72. Epub 2020 Sep 2.

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Objective: To assess the association between the change in statewide smoke-free laws and the rate of preterm or low birth weight delivery hospitalizations.

Data Source: 2002-2013 Healthcare Cost and Utilization Project State Inpatient Databases.

Study Design: Quasi-experimental difference-in-differences design. We used multivariate logistic models to estimate the association between the change in state smoke-free laws and preterm or low birth weight delivery hospitalizations. The analyses were also stratified by maternal race/ethnicity to examine the differential effects by racial/ethnic groups.

Data Collection/extraction Methods: Delivery hospitalizations among women aged 15-49 years were extracted using the International Classification of Diseases, Ninth Revision, and Diagnosis-Related Group codes.

Principal Findings: Non-Hispanic black mothers had a higher rate of preterm or low birth weight delivery hospitalization than other racial/ethnic groups. Overall, there was no association between the change in smoke-free laws and preterm or low birth weight delivery rate. Among non-Hispanic black mothers, the change in statewide smoke-free laws was associated with a 0.9-1.9 percentage point (P < .05) reduction in preterm or low birth weight delivery rate beginning in the third year after the laws took effect. There was no association among non-Hispanic white mothers. A decline in the black-white disparity of 0.6-1.6 percentage points (P < .05) in preterm or low birth weight delivery rates was associated with the change in state smoke-free laws.

Conclusion: The change in state smoke-free laws was associated with a reduction in racial/ethnic disparities in preterm or low birth weight delivery hospitalizations in selected US states.
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http://dx.doi.org/10.1111/1475-6773.13552DOI Listing
February 2021

National Health Care Expenditures Associated With Disability.

Med Care 2020 09;58(9):826-832

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.

Background: In 2003, national disability-associated health care expenditures (DAHE) were $398 billion. Updated estimates will improve our understanding of current DAHE.

Objective: The objective of this study was to estimate national DAHE for the US adult population and analyze spending by insurance and service categories and to assess changes in spending over the past decade.

Research Design: Data from the 2013-2015 Medical Expenditure Panel Survey were used to estimate DAHE for noninstitutionalized adults. These estimates were reconciled with National Health Expenditure Accounts (NHEA) data and adjusted to 2017 medical prices. Expenditures for institutionalized adults were added from NHEA data.

Measures: National DAHE in total, by insurance and service categories, and percentage of total expenditures associated with disability.

Results: DAHE in 2015 were $868 billion (at 2017 prices), representing 36% of total national health care spending (up from 27% in 2003). DAHE per person with disability increased from $13,395 in 2003 to $17,431 in 2015, whereas nondisability per-person spending remained constant (about $6700). Public insurers paid 69% of DAHE. Medicare paid the largest portion ($324.7 billion), and Medicaid DAHE were $277.2 billion. More than half (54%) of all Medicare expenditures and 72% of all Medicaid expenditures were associated with disability.

Conclusions: The share of health care expenditures associated with disability has increased substantially over the past decade. The high proportion of DAHE paid by public insurers reinforces the importance of public programs designed to improve health care for people with disabilities and emphasizes the need for evaluating programs and health services available to this vulnerable population.
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http://dx.doi.org/10.1097/MLR.0000000000001371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505687PMC
September 2020

Alcohol screening and brief intervention in emergency departments: Review of the impact on healthcare costs and utilization.

J Subst Abuse Treat 2020 10 4;117:108096. Epub 2020 Aug 4.

University of North Carolina at Greensboro, Bryan School of Business and Economics, Department of Economics, 462 Bryan Building, PO Box 26170, Greensboro, NC 27402, USA.

Purpose: To review the published evidence of the impact of alcohol screening and brief intervention (SBI) delivered in emergency departments (EDs) on healthcare utilization and costs.

Principal Results: This scoping review used existing literature reviews supplemented with an electronic database. We included studies if they assessed SBIs for alcohol delivered in an ED setting and reported healthcare utilization and/or costs. We abstracted methodological approaches and healthcare utilization outcomes from each study and categorized them based on substance of focus (alcohol only vs. alcohol and other substances). We updated cost estimates from each study to 2018 U.S. dollars. We identified seven studies published between 2010 and 2019 that met study inclusion criteria. Two of the seven studies evaluated SBI that targeted both alcohol and other substances. Six studies found a reduction in healthcare utilization or costs, and one found an increase in healthcare utilization.

Major Conclusions: This literature review suggests that SBI delivered in ED settings can be a cost-reducing approach to treating excessive alcohol consumption, a factor that policy-makers and payers might consider in prioritizing interventions.
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http://dx.doi.org/10.1016/j.jsat.2020.108096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547910PMC
October 2020

Early Hearing Detection and Intervention in the United States: Achievements and Challenges in the 21 Century.

China CDC Wkly 2020 May;2(21):378-382

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States.

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http://dx.doi.org/10.46234/ccdcw2020.097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413595PMC
May 2020

Treatment Discontinuation within 3 Years of Levothyroxine Initiation among Children Diagnosed with Congenital Hypothyroidism.

J Pediatr 2020 08 11;223:136-140. Epub 2020 May 11.

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.

Objectives: To measure the rates of thyroid gland imaging and levothyroxine (L-T) discontinuation and to assess whether discontinuation was monitored with thyroid-stimulating hormone testing in subjects with congenital hypothyroidism.

Study Design: This is a retrospective analysis of claims data from the IBM MarketScan Databases for children born between 2010 and 2016 and continuously enrolled in a noncapitated employer-sponsored private health insurance plan or in Medicaid for ≥36 months from the date of the first filled L-T prescription.

Results: There were 263 privately insured and 241 Medicaid-enrolled children who met the inclusion criteria. More privately insured than Medicaid-enrolled children had imaging between the first filled prescription and 180 days after the last filled prescription (24.3% vs 12.9%; P = .001). By 36 months, 35.7% discontinued L-T, with no difference by insurance status (P = .48). Among those who discontinued, 29.1% of privately insured children and 47.7% of Medicaid-enrolled children had no claims for thyroid-stimulating hormone testing within the next 180 days (P = .01).

Conclusions: Nearly one-third of children with suspected congenital hypothyroidism discontinued L-T by 3 years and fewer Medicaid-enrolled than privately insured children received timely follow-up thyroid-stimulating hormone testing. Future studies are indicated to understand the quality of care and developmental outcomes for children with congenital hypothyroidism and barriers to guideline adherence in evaluating for transient congenital hypothyroidism.
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http://dx.doi.org/10.1016/j.jpeds.2020.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427425PMC
August 2020

Fragile X Syndrome-Associated Emergency Department Visits in the United States, 2006-2011.

Am J Intellect Dev Disabil 2020 03;125(2):103-108

Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities.

Using national data, we examined emergency department (ED) encounters during 2006-2011 for which a diagnosis code for fragile X syndrome (FXS) was present ( = 7,217). Almost half of ED visits coded for FXS resulted in hospitalization, which is much higher than for ED visits not coded for FXS. ED visits among females coded for FXS were slightly more likely to result in hospitalization. These findings underscore the importance of surveillance systems that could accurately identify individuals with FXS, track healthcare utilization and co-occurring conditions, and monitor quality of care in order to improve care and reduce FXS-associated morbidity.
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http://dx.doi.org/10.1352/1944-7558-125.2.103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305836PMC
March 2020

Infant Mortality Attributable to Birth Defects - United States, 2003-2017.

MMWR Morb Mortal Wkly Rep 2020 Jan 17;69(2):25-29. Epub 2020 Jan 17.

Birth defects are a leading cause of infant mortality in the United States, accounting for 20.6% of infant deaths in 2017 (1). Rates of infant mortality attributable to birth defects (IMBD) have generally declined since the 1970s (1-3). U.S. linked birth/infant death data from 2003-2017 were used to assess trends in IMBD. Overall, rates declined 10% during 2003-2017, but decreases varied by maternal and infant characteristics. During 2003-2017, IMBD rates decreased 4% for infants of Hispanic mothers, 11% for infants of non-Hispanic black (black) mothers, and 12% for infants of non-Hispanic white (white) mothers. In 2017, these rates were highest among infants of black mothers (13.3 per 10,000 live births) and were lowest among infants of white mothers (9.9). During 2003-2017, IMBD rates for infants who were born extremely preterm (20-27 completed gestational weeks), full term (39-40 weeks), and late term/postterm (41-44 weeks) declined 20%-29%; rates for moderate (32-33 weeks) and late preterm (34-36 weeks) infants increased 17%. Continued tracking of IMBD rates can help identify areas where efforts to reduce IMBD are needed, such as among infants born to black and Hispanic mothers and those born moderate and late preterm (32-36 weeks).
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http://dx.doi.org/10.15585/mmwr.mm6902a1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973351PMC
January 2020

Ensuring the Life-Span Benefits of Newborn Screening.

Pediatrics 2019 12 6;144(6). Epub 2019 Nov 6.

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; and.

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http://dx.doi.org/10.1542/peds.2019-0904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202673PMC
December 2019

The financial and time burden associated with phenylketonuria treatment in the United States.

Mol Genet Metab Rep 2019 Dec 16;21:100523. Epub 2019 Oct 16.

Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States of America.

Background: Phenylketonuria (PKU) imposes a substantial burden on people living with the condition and their families. However, little is known about the time cost and financial burden of having PKU or caring for a child with the condition.

Methods And Findings: Primary data were collected with a detailed cost and utilization survey. Primary outcomes included utilization and out-of-pocket costs of medical services, medical formula, and prescribed low-protein food consumption, as well as the time and perceived effort involved in following the PKU diet. Respondents were people living with PKU or parents of children with PKU identified through a state newborn screening program database. Secondary administrative claims data were also used to calculate mean total, insurer, and out-of-pocket payments in inpatient, outpatient (office visits, emergency room, and laboratory tests), and pharmacy settings for privately insured persons with PKU. Payments were calculated for sapropterin and for PKU formula.In primary data analysis (children  = 32, adults  = 52), annual out-of-pocket costs were highest for low-protein foods (child = $1651; adult = $967) compared with other categories of care. The time burden of PKU care was high; families reported spending more than 300 h per year shopping for and preparing special diet foods.In secondary data analysis, children 12-17 years old had the highest average medical expenditures ($54,147;  = 140) compared to children 0-11 years old ($19,057;  = 396) and adults 18 years and older ($40,705;  = 454). Medication costs were the largest contributor to medical costs, accounting for 61-81% of total costs across age groups. Sapropterin was the largest driver of medication costs, accounting for 85% of child medication costs and 92% of adult medication costs.

Conclusion: Treatment for PKU incurs a substantial time and cost burden on persons with PKU and their families. Estimated medical expenditures using claims data varied by age group, but sapropterin represented the largest cost for PKU treatment from a payer perspective across age groups.
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http://dx.doi.org/10.1016/j.ymgmr.2019.100523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6807265PMC
December 2019

Exome sequencing: value is in the eye of the beholder.

Genet Med 2020 02 14;22(2):280-282. Epub 2019 Oct 14.

Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA.

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http://dx.doi.org/10.1038/s41436-019-0674-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202672PMC
February 2020

Avoiding Harm From Hyperbilirubinemia Screening-Reply.

JAMA Pediatr 2019 Oct 7. Epub 2019 Oct 7.

Department of Pediatrics, The University of Utah, Salt Lake City.

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http://dx.doi.org/10.1001/jamapediatrics.2019.3762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203610PMC
October 2019

Data needed to respond appropriately to anemia when it is a public health problem.

Ann N Y Acad Sci 2019 08 2;1450(1):268-280. Epub 2019 Jul 2.

Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.

Although the proportion of anemia amenable to change varies by population, the World Health Organization (WHO) criteria used to describe the public health severity of anemia are based on population prevalences. We describe the importance of measuring iron and other etiologic indicators to better understand what proportion of anemia could be responsive to interventions. We discuss the necessity of measuring inflammation to interpret iron biomarkers and documenting anemia of inflammation. Finally, we suggest assessing nonmodifiable genetic blood disorders associated with anemia. Using aggregated results from the Global Burden of Disease 2016, we compare population prevalence of anemia with years lived with disability (YLD) estimates, and the relative contributions of mild, moderate, and severe anemia to YLD. Anemia prevalences correlated with YLD and the relative proportion of moderate or severe anemia increased with anemia prevalence. However, individual-level survey data revealed irregular patterns between anemia prevalence, the prevalence of moderate or severe anemia, and the prevalence of iron deficiency anemia (IDA). We conclude that although the WHO population prevalence criteria used to describe the public health severity of anemia are important for policymaking, etiologic-specific metrics that take into account IDA and other causes will be necessary for effective anemia control policies.
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http://dx.doi.org/10.1111/nyas.14175DOI Listing
August 2019

Screening for Neonatal Hyperbilirubinemia-First Do No Harm?

JAMA Pediatr 2019 07;173(7):617-618

Department of Pediatrics, University of Utah, Salt Lake City.

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http://dx.doi.org/10.1001/jamapediatrics.2019.1194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688481PMC
July 2019

A practical guide to episode groupers for cost-of-illness analysis in health services research.

SAGE Open Med 2019 29;7:2050312119840200. Epub 2019 Mar 29.

Bureau of Economic Analysis, Washington, DC, USA.

Despite the prominence of episode groupers for analysis and reimbursement in US payer settings, peer-reviewed articles using episode groupers for cost-of-illness analysis that informs public health research and decision-making are uncommon. This article provides a brief practical guide to episode-based cost analysis and offers some examples of episode grouper products. It is intended for an audience of health services researchers and managers in public health settings who perform or commission cost-of-illness studies with the US healthcare claims fee-for-service data but lack familiarity with episode groupers.
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http://dx.doi.org/10.1177/2050312119840200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444409PMC
March 2019

Quantifying Family Spillover Effects in Economic Evaluations: Measurement and Valuation of Informal Care Time.

Pharmacoeconomics 2019 04;37(4):461-473

Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Spillover effects on the welfare of family members may refer to caregiver health effects, informal care time costs, or both. This review focuses on methods that have been used to measure and value informal care time and makes suggestions for their appropriate use in cost-of-illness and cost-effectiveness analyses. It highlights the importance of methods to value informal care time that are independent of caregiver health effects in order to minimize double counting of spillover effects. Although the concept of including caregiver time costs in economic evaluations is not new, relatively few societal perspective cost-effectiveness analyses have included informal care, with the exception of dementia. This is due in part to challenges in measuring and valuing time costs. Analysts can collect information on time spent in informal care or can assess its impact in displacing other time use, notably time in paid employment. A key challenge is to ensure appropriate comparison groups that do not require informal care to be able to correctly estimate attributable informal care time or foregone market work. To value informal care time, analysts can use estimates of hourly earnings in either opportunity cost or replacement cost approaches. Researchers have used widely varying estimates of hourly earnings. Alternatively, stated-preference methods (i.e. contingent valuation, conjoint analysis) can be used to value the effect of informal care on utility, but this can entail double counting with health effects. Lack of consensus and standardization of methods makes it difficult to compare estimates of informal care costs.
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http://dx.doi.org/10.1007/s40273-019-00782-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529092PMC
April 2019