Systematic Literature Review of the Costs of Pregnancy in the US
The cost of pregnancy is increasing over time despite the decline in pregnancy rates.
To fully elucidate and evaluate the cost drivers of pregnancy in the US for payers, a systematic review was conducted to understand the main cost components and primary factors that contribute to the direct costs of pregnancy, pregnancy-related complications and unintended pregnancy among women of childbearing age (15–44 years).
We performed electronic searches in the PubMed database from January 2000 to December 2012, and major women’s health and pharmacoeconomics conference proceedings from 2011 to 2012.
The systematic review is comprised of studies that reported pregnancy, pregnancy-related complications, unplanned pregnancy, and pregnancy-induced monetary costs. The review excluded narrative reports, systematic reviews, model-derived cost of pregnancy papers, non-US-based studies, and reports based solely on expert opinions.
Study Appraisal and Synthesis Methods
Two reviewers independently applied the inclusion criteria and assessed the quality of the data collected. Disagreements between reviewers were resolved by consensus or by arbitration through a third party, with reference to the original sources. We collected information on the study design and outcomes for each included study. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines in designing, performing, and reporting of the systematic review.
We identified 40 studies from electronic and handsearching methods. We classified studies based on the primary research topic focusing on the overall cost of pregnancy (N = 10), cost of pregnancy-related complications (N = 26), cost of unintended pregnancy (N = 2), cost of planned pregnancy (N = 1), or cost of pregnancy by facilities (N = 1). In the quality assessment, randomized, non-randomized, and retrospective database studies had low to moderate risk of bias. We determined primary cost drivers based on the highest cost reported in each study. The identified cost drivers were inpatient care, pregnancy delivery, multiple births, complicated cesarean sections, high-risk pregnancy, preterm birth, low birth weight, complications due to conditions such as hypertension, diabetes, anemia, and cancer, and in vitro fertilization. In 2008, the overall mean cost per hospital stay for pregnancy-related incidence ranged from $3,306 to $9,234 in 2012 dollars. The mean cost of pregnancy-related complications that led to preterm birth was as high as $326,953 for an infant born at 25 weeks. It is estimated that over 50 % of live births were unintended in the US. The difference in the cost of unintended pregnancy and intended pregnancy was approximately $536 million.
One limitation of the systematic review was the exclusion of model-based cost studies which were excluded because of the high level of variation and heterogeneity across sources of reported cost. Another limitation of the review is that the cost of pregnancy perspective is restricted to the US.
Preventing pregnancy-related complications and reducing unintended pregnancies may lower the overall economic burden of pregnancy on the US health care system.
- 1.Ventura S, et al. Estimated pregnancy rates and rates of pregnancy outcome for the United States, 1990–2008. National Vital Stat Rep. 2012;60(7):1–21.Google Scholar
- 2.Mosher WD, Jones J, Abma JC. Intended and unintended births in the United States: 1982–2010. Natl Health Stat Rep. 2012;55:1–28.Google Scholar
- 3.Abma J, Martinez G, Copen C. Teenagers in the United States: sexual activity, contraceptive use, and childbearing, national survey of family growth 2006–2008. Vital Health Stat. 2010;23(30):1–47.Google Scholar
- 4.The healthcare costs of having a baby. Thomson Healthcare; 2007.Google Scholar
- 5.Wier LM, Andrews RM. The national hospital bill: the most expensive conditions by payer, 2008. Statistical brief #107. Healthcare Cost and Utilization Project (HCUP). Rockville: Agency for Healthcare Research and Quality; 2006.Google Scholar
- 6.Agency for Healthcare Research and Quality (AHRQ). 2010 national statistics on all stays. Available from: http://hcupnet.ahrq.gov/HCUPnet.jsp. Accessed 1 Apr 2013.
- 9.Total Expenses and Percent Distribution for Selected Conditions by Source of Payment: United States, 2010. Medical expenditure panel survey household component data. Agency for Healthcare Research and Quality; 2010.Google Scholar
- 10.Zupancic JA. The economics of elective cesarean section. Clin Perinatol. 2008;35(3):591–9, xii.Google Scholar
- 11.MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol. 2008;35(2):293–307, v.Google Scholar
- 13.Higgins JPT, Green, S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. Available from: http://www.cochrane-handbook.org/. Accessed 6 Aug 2012.
- 14.Wells G, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 6 Aug 2012.
- 16.Liberati A, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.Google Scholar
- 17.Fitch K, Johnson R, Pyenson B, Costales A, Law AW. Costs of contraceptive coverage and pregnancy care: an actuarial analysis. J Manag Care Pharmacy. 2011;17(3):242.Google Scholar
- 19.Machlin SR, Rohde F. Health care expenses for uncomplicated pregnancies. Research Findings No. 27. Rockville: Agency for Healthcare Research and Quality; 2007.Google Scholar
- 20.Main J, et al. Median costs and outcomes related to multiple gestations. Am J Obstet Gynecol. 2011:S66.Google Scholar
- 21.Merrill C, Steiner C. Hospitalizations related to childbirth, 2003. Statistical brief #11. Healthcare Cost and Utilization Project (HCUP). Rockville: Agency for Healthcare Research and Quality; 2006.Google Scholar
- 22.Podulka J, Stranges E, Steiner C. Hospitalizations related to childbirth, 2008. Statistical brief #110. Healthcare Cost and Utilization Project (HCUP). Rockville: Agency for Healthcare Research and Quality; 2011.Google Scholar
- 34.Thorsen N, Khalil L. Cost savings associated with smoking cessation for low-income pregnant women. WMJ. 2004;103(5):67–9, 73.Google Scholar
- 36.Brooten D, et al. A randomized trial of nurse specialist home care for women with high-risk pregnancies: outcomes and costs. J Manag Care. 2001;7(8):793–803.Google Scholar
- 37.Jones JS, et al. Is 34 weeks an acceptable goal for a complicated singleton pregnancy? J Manag Care. 2002;11(10):42–7.Google Scholar
- 48.Nicholson J, et al. The active management of risk in pregnancy at term (AMOR-IPAT) cost-effectiveness study. Am J Obstet Gynecol. 2011:S63.Google Scholar
- 49.Morrison J, et al. Telemedicine: cost-effective management of high-risk pregnancy. J Manag Care. 2001;10(11):42–6, 48–9.Google Scholar
- 51.Rolnick SJ, et al. Impact of birthweight on healthcare charges within a managed care organization. J Manag Care. 2000;6(12):1289–96.Google Scholar
- 53.Unal ER, et al. Planned evening labor induction: the cost of convenience. Am J Obstet Gynecol. 2012:S280.Google Scholar