Health care expenditures for infants and young children with Down syndrome in a privately insured population.

Abstract

To use health care insurance claims data from a privately insured population to estimate health care use and expenditures for infants and children aged 0 to 4 years with Down syndrome. Data from the 2004 Medstat MarketScan database were used to estimate medical care use and expenditures related to inpatient admissions, outpatient services, and prescription drug claims for children with and those without Down syndrome. Costs were further stratified by the presence or absence of a congenital heart defect (CHD). The mean medical costs for infants and children with Down syndrome were $36384 during 2004; median medical costs were $11164. Mean and median medical costs for children 0 to 4 years of age with Down syndrome were 12 to 13 times higher than for children without Down syndrome. For infants with Down syndrome and CHDs, mean and median costs were 5 to 7 times higher than for infants with Down syndrome who did not have CHDs. These findings may facilitate future assessments of the effect of the Down syndrome on the health care system.