Medical Costs of Children Admitted to the Neonatal Intensive Care Unit: the Role and Possible Economic Impact of WES in Early Diagnosis

Abstract Objective: The objective of this study is to provide an overview of average healthcare costs for patients admitted to the Neonatal Intensive Care Unit (NICU) and to assess possible impact of implementing Whole Exome Sequencing (WES) on these total healthcare costs.Methods: We retrospectively collected postnatal healthcare data of all patients admitted to the level IV NICU at the Radboudumc (October 2013-October 2015) and linked unit costs to these healthcare consumptions. Average healthcare costs were calculated and a distinction between patients was made based on performance of genetic tests and the presence of congenital anomalies (CAs).Results: Overall, €26,627 was spend per patient. Genetic costs accounted for 2.3% of all costs. Healthcare costs were higher for patients with CAs compared to patients without CAs. Patients with genetic diagnostics were also more expensive then patients without genetic diagnostics. When performing trio-WES for all patients instead of current diagnostics, overall healthcare costs will increase with 22.2%. In case only patients with CAs receive trio-WES, average per patient healthcare costs will increase with 5.3%. Performing trio-WES only for patients with multiple CAs did not result in any cost changes.Conclusions: Genetic diagnostic testing accounted for a small fraction of total costs. By implementing trio-WES as genetic diagnostic test for all patients with CAs there is a limited increase in overall healthcare budget. Not only the diagnostic yield of this cohort will increase, but implementing trio-WES for all patients with CAs may also allow for improved personalized treatments options guided by the diagnoses made.