Medicaid picks up tab for rising NAS costs

U.S. healthcare costs associated with neonatal abstinence syndrome (NAS) climbed from $39,400 in 2000 to $53,400 in 2009, and state Medicaid programs paid for the majority of the cases. Approximately 3.39 per 1,000 hospital births in 2009 involved NAS, compared with 1.20 in 2000, according to a report from JAMA published online (http://jama.ama-assn.org/content/early/2012/04/25/jama.2012.3951.full?papetoc).

NAS is a postnatal drug withdrawal syndrome that is primarily caused by maternal opiate use. It is characterized by an increased incidence of seizures, respiratory symptoms, feeding difficulties, and low birth weight, according to the retrospective, serial, cross-sectional analysis of discharged newborns made in 2000, 2003, 2006, and 2009.

“Prolonged neonatal intensive care unit care may result in complications and require extended use of opiate medications, resulting in withdrawal symptoms in newborns not exposed to opiates in the antenatal period. In total, these newborns included fewer than 5% of all NAS births in all study years…. Newborns with iatrogenic NAS were excluded from our analysis,” the authors noted.

Antepartum maternal opiate use also increased from 1.19 per 1,000 hospital births in 2000 to 5.63 in 2009. “Similar to newborns diagnosed with NAS, mothers using opiates were more likely than mothers not using opiates to be covered by Medicaid (60%),” the authors said.

The length of stay was approximately 16 days for a newborn with NAS, compared to 3 days for other hospital births. Medicaid paid for the majority of NAS infant cases, which increased from 68.7% in 2000 to 77.6% in 2009.

States need to find innovative ways to address NAS and lower the cost of this burden as state Medicaid programs pay for the majority of these cases, the authors concluded.