Estimating the Cost of Preeclampsia in the Healthcare System

Abstract

To estimate the cost of preeclampsia from the national health payer's perspective using secondary data from the SCOPE study (Screening for Pregnancy End Points). SCOPE is an international observational prospective study of healthy nulliparous women with singleton pregnancies. Using data from the Irish cohort recruited between November 2008 and February 2011, all women with preeclampsia and a 10% random sample of women without preeclampsia were selected. Additional health service use data were extracted from the consenting participants' medical records for maternity services which were not included in SCOPE. Unit costs were based on estimates from 3 existing Irish studies. Costs were extrapolated to a national level using a prevalence rate of 5% to 7% among nulliparous pregnancies. Within the cohort of 1774 women, 68 developed preeclampsia (3.8%) and 171 women were randomly selected as controls. Women with preeclampsia used higher levels of maternity services. The average cost of a pregnancy complicated by preeclampsia was €5243 per case compared with €2452 per case for an uncomplicated pregnancy. The national cost of preeclampsia is between €6.5 and €9.1 million per annum based on the 5% to 7% prevalence rate. Postpartum care was the largest contributor to these costs (€4.9-€6.9 million), followed by antepartum care (€0.9-€1.3 million) and peripartum care (€0.6-€0.7 million). Women with preeclampsia generate significantly higher maternity costs than women without preeclampsia. These cost estimates will allow policy-makers to efficiently allocate resources for this pregnancy-specific condition. Moreover, these estimates are useful for future research assessing the cost-effectiveness of preeclampsia screening and treatment.

Economic burden of maternal morbidity – A systematic review of cost-of-illness studies

“…There was also a lack of sensitivity analysis exploring the impact of uncertainty relating to the prevalence of particular health problems, treatment rates, and unit prices, with only 12 studies (3%) reporting some form of sensitivity analysis, and one reporting having used conservative estimates to mitigate parameter uncertainty. [20,21,[25][26][27][28][29][30][31][32][33][34][35]…”

“…Hypertensive disorders included both confirmed pre-eclampsia (one Irish and one US study [25,56]) and hypertension during pregnancy (three studies set in the US [30,37,56]), with all hypertension studies examining different costs (mothers only, children only or mother and children combined). Incremental costs per case for hypertension ranged from €2,860 to €8,595 (Table 4).…”

Cost Effectiveness of Antenatal Lifestyle Interventions for Preventing Gestational Diabetes and Hypertensive Disease in Pregnancy

“…Health service use for pregnancy-related conditions was determined by developing separate patient pathways for women with (1) gestational diabetes; (2) hypertensive disease in pregnancy; or (3) both, to determine an approximation of the type and quantity of services likely to have been accessed by health service users. Patient pathways were developed through the use of clinical guidelines, Monash Health pathways and policies [27][28][29], relevant publications [7,30,31] The average costs for these pathways were calculated for the cost year of 2019. The cost of antenatal gestational diabetes was estimated as AUD1055, antenatal hypertensive disease in pregnancy was estimated as AUD1723, and the cost of having both conditions was estimated as AUD2471.…”

“…Many women enter pregnancy at a higher than recommended weight, and approximately 45% of women gain weight in pregnancy in excess of international guidelines [2][3][4]. Excessive gestational weight gain is a risk factor for gestational diabetes and pre-eclampsia, which are common antenatal conditions with serious adverse maternal and infant outcomes over the short and longer term [5][6][7][8]. Recent Australian figures suggest that one in seven women will develop gestational diabetes during pregnancy, and that women with gestational diabetes are more likely to be diagnosed with hypertensive disease in pregnancy [9].…”

Therapeutic heparin during the peripartum period

“…Further research may aid in the development of a guideline incorporating a low target APTT range nomogram to provide a standardised approach for the management and monitoring of UFH in the postnatal peripartum period. As identified in Phase 2, clinicians favoured the use of LMWH in the postnatal peripartum period for women considered at both low and high risk of rethrombosis which could also be the focus of further investigation.Future studies could also be expanded to include health economic analysis of peripartum anticoagulation in relation to length of hospital stay, resource use and clinical outcomes.Studies estimating the costs associated with pregnancy-specific conditions may aid in the efficient allocation of scarce health resources(142).…”