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Ciaran S. Phibbs, PhD; David A. Bateman, MD; Rachel M. Schwartz, MPH

JAMA. 1991;266(11):1521-1526.

Abstract
Objective.
—To examine the added neonatal cost and length of hospital stay associated with fetal cocaine exposure.

Design.
—All cocaine-exposed infants in the study population (n=355) were compared with a random sample of unexposed infants (n=199). Regression analysis was used to control for the independent effects of maternal age, smoking, alcohol consumption, prenatal care, race, gravidity, and sex of the infant.

Setting.
—A large, public, inner-city hospital studied from 1985 to 1986.

Patients.
—All infants were routinely tested for illicit substances, records were reviewed for maternal histories of substance abuse, and all known cocaineexposed singleton infants were included.

Main Outcome Measures.
—Cost and length of stay until each infant was medically cleared for hospital discharge and cost and length of stay until each infant was actually discharged from the hospital.

Results.
—Neonatal hospital costs until medically cleared for discharge were $5200 more for cocaine-exposed infants than for unexposed infants (a difference of $7957 vs $2757 [P=.003]). The costs of infants remaining in the nursery while awaiting home and social evaluation or foster care placement increased this difference by more than $3500 (P<.0001). Compared with other forms of cocaine, fetal exposure to crack was associated with much larger cost increases ($6735 vs $1226). Exposure to other illicit substances in addition to cocaine was also associated with much larger cost increases ($8450 vs $1283).

Conclusions.
—At the national level, we estimate that these individual medical costs add up to about $500 million. The large magnitude of these costs indicates that effective treatment programs for maternal cocaine abusers could yield savings within their first year of operation.

(JAMA. 1991;266:1521-1526)

Author Affiliations
From the Division of Health Policy and Management, Columbia University School of Public Health, New York, NY (Dr Phibbs); the Institute for Health Policy Studies, University of California, San Francisco (Dr Phibbs); the Department of Pediatrics, College of Physicians and Surgeons, Columbia University and Harlem Hospital, New York, NY (Dr Bateman); and the National Perinatal Information Center, Providence, RI (Ms Schwartz). Dr Phibbs is now with the Center for Health Care Evaluation, Palo Alto (Calif) Veterans Affairs Medical Center.

Footnotes
Reprint requests to Center for Health Care Evaluation (152MP), Veterans Affairs Medical Center, 795 Willow Rd, Menlo Park, CA 94025 (Dr Phibbs).

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