Cost-effectiveness of treatment for drug-abusing pregnant women

Neonatal intensive care unit (NICU) and drug treatment costs were compared in two groups of pregnant drug abusing women: 100 admissions to a multidisciplinary treatment program and active in care at the time of delivery and 46 controls not entering drug treatment. Clinical measures included urine toxicology at delivery, infant birthweight. Apgar scores and need for and duration of NICU services. Cost measures included drug treatment and NICU costs. Treatment patients showed better clinical outcome at delivery, with less drug use and higher infant estimated gestational age, birthweight and Apgar scores. Infants of treatment patients were also less likely to require NICU services and, for those that did, had a shorter stay. When total cost was examined (including drug treatment), mean net savings for treatment subjects was $4644 per mother/infant pair. The study demonstrates the cost-effectiveness of treatment for pregnant drug abusing women, with savings in NICU costs exceeding costs of drug treatment.

The cost of poor birth outcomes in employer-sponsored health plans

OBJECTIVES

The authors examine the cost and incidence of poor birth outcomes in employer-sponsored health insurance plans.

METHODS

An extensive study of national inpatient and outpatient claims data for prenatal, delivery, and postnatal care of nearly 59,000 mother-infant pairs was conducted. All maternal and infant costs incurred over a 2-year period were analyzed, and, furthermore, the longitudinal claims experience of a cohort of 20,000 mothers and infants was examined in detail.

RESULTS

The study revealed that 25% of deliveries resulted in poor birth outcomes, which accounted for 40% of total costs over a 2-year period. Extrapolated nationwide, the net direct medical care cost of poor birth outcomes in employer plans has been estimated at approximately $5.6 billion for 1990, approximately 3% of aggregate after-tax corporate profits that year.

CONCLUSIONS

Costs related to maternity and infant care are a major source of cost for employer-sponsored health insurance plans. Poor birth outcomes represent significantly higher cost for both the mother and infant at all stages of care-prenatal, at birth, and postnatal. To the extent that poor birth outcomes relate to maternal behavior and are preventable, their very high and protracted cost may justify substantial health promotion activity by employers and insurers.

The effect of expansions in Medicaid income eligibility on abortion

In this paper we examine the effect of expansions in Medicaid income eligibility on abortion, using individual-level data from South Carolina, Tennessee, and Virginia. The results suggest that for unmarried nonblack women with less than a high school degree, expansions of income eligibility lowered the probability of abortion by two to five percentage points. Most of the impact of the Medicaid expansions on abortion occurred in the first round of expansions from approximately 45% of the federal poverty level to 100%. For black unmarried women with less than a high school degree, we generally find no effect of expansions in Medicaid income eligibility on abortion.

Multiple pregnancies: the price to pay

Since 1980, the rate of multiple pregnancies due to assisted reproductive technology has been multiplied by 10, especially for twin pregnancies and for cases involving simple stimulation of ovulation. The prices paid are: an increase in prematurity (82% of deliveries); perinatal mortality (an increase of 74%); and transfer to intensive care units (95% of infants born of multiple pregnancies). This does not take into account the rise in cost per child, which increased by 1.9 for twins and 3.7 for triplets. The solution does not lie in selective embryo reduction but in the reduction of the number of embryos transferred.

Cost analysis of in vitro fertilization

In vitro fertilization (IVF) has become a routine tool in the arsenal of infertility treatments. Assisted reproductive techniques are expensive, as reflected by the current "take home baby" rate of about 15% per cycle, implying the need for repeated attempts until success is achieved. Israel, today is facing a major change in its health care system, including the necessity to define a national package of health care benefits. The issue of infertility and whether its treatment should be part of the "health basket" is in dispute. Therefore an exact cost analysis of IVF is important. Since the cost of an IVF cycle varies dramatically between countries, we sought an exact breakdown of the different components of the costs involved in an IVF cycle and in achieving an IVF child in Israel. The key question is not how much we spend on IVF cycles but what is the cost of a successful outcome, i.e., a healthy child. This study intends to answer this question, and to give the policy makers, at various levels of the health care system, a crucial tool for their decision-making process. The cost analysis includes direct and indirect costs. The direct costs are divided into fixed costs (labor, equipment, maintenance, depreciation, and overhead) and variable costs (laboratory tests, chemicals, disposable supplies, medications, and loss of working days by the couples). The indirect costs are the costs of premature IVF babies, hospitalization of the IVF pregnant women in a high risk unit, and the cost of complications of the procedure. According to our economic analysis, an IVF cycle in Israel costs $2,560, of which fixed costs are about 50%. The cost of a "take home baby" is $19,267, including direct and indirect costs.

Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes

OBJECTIVE

To develop a consensus on the use of antenatal corticosteroids for fetal maturation in preterm infants.

PARTICIPANTS

A nonfederal, nonadvocate, 16-member consensus panel including representatives from neonatology, obstetrics, family medicine, behavioral medicine, psychology, biostatistics, and the public; 19 experts in neonatology, obstetrics, and pharmacology presented data to the consensus panel and a conference audience of approximately 500.

EVIDENCE

An extensive bibliography of references was produced for the consensus panel and the conference audience using a variety of on-line databases including MEDLINE. The consensus panel met several times prior to the conference to review the literature. It also commissioned an updated meta-analysis, a neonatal registry review, and an economic analysis that were presented at the conference. The experts prepared abstracts for distribution at the conference, presented data, and answered questions from the panel and audience. The panel evaluated the strength of the scientific evidence using the grading system developed by the Canadian Task Force on the Periodic Health Examination and adapted by the US Preventive Services Task Force.

CONSENSUS

The consensus panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature.

CONSENSUS STATEMENT

The consensus panel composed a draft statement that was read in its entirety at the conference for comment. The panel released a revised statement at the end of the conference and finalized the revisions a few weeks after the conference.

CONCLUSIONS

Antenatal corticosteroid therapy is indicated for women at risk of premature delivery with few exceptions and will result in a substantial decrease in neonatal morbidity and mortality, as well as substantial savings in health care costs. The use of antenatal corticosteroids for fetal maturation is a rare example of a technology that yields substantial cost savings in addition to improving health.

The cost effectiveness of prenatal care

This study uses hospital records for 7,000 births in McLennan County, Texas, during the period June 1987-July 1989 to examine the association between prenatal care and birth outcome and the implications for hospital costs of newborn infants. After controlling for a variety of maternal and birth factors, a significant relationship between prenatal care and birth outcome remained. Females who failed to receive prenatal care were almost three times as likely to have a low-birth-weight infant (weighing less than 2,500 grams) than females who did. Using an ordinary least squares (OLS) estimating equation (R2 = .24), the net expected hospital cost savings for females who received prenatal care was over $1,000.

Cost differences between low birthweight attributable to smoking and low birthweight for all causes

BACKGROUND

Low birthweight (< 2,500 g) is one of the major predictors of infant mortality. The clinical salience of low birthweight depends on its severity. The impact of smoking on low birthweight is greater in the 1,500-2,499-gm category than below 1,500 gm. This has an important implication for economic analyses of smoking cessation programs for pregnant women. Because health care cost is closely associated with birthweight, the cost of low birthweight attributable to smoking may be different than the average cost of low birthweight for all causes. Little is known about such cost differences.

METHODS

The population-attributable risk was used to estimate the number and percentage of low-birthweight infants due to maternal smoking. Costs by birthweight groups were used to determine cost differences between low birthweight due to smoking and for all causes.

RESULTS

The net incremental costs per low birthweight due to smoking range from $4,256 to $8,640 compared to the costs of $5,213 to $10,306 per low birthweight by all causes. The cost differences may be up to 18%.

CONCLUSION

Considerably lower costs at birth were found in low birthweight due to smoking than for all causes. The cost difference was attributable to the difference in the severity of low birthweight.

The effectiveness of Florida's "Improved Pregnancy Outcome" program

The development of a national program to assure access to prenatal care for all women, regardless of income, is believed to be an effective means of reducing low birthweight and neonatal mortality in the U.S. Yet scarce empirical evidence concerning the effectiveness of large-scale prenatal care programs is available. This paper summarizes an evaluation of a statewide public prenatal care program which grew out of the federal Improved Pregnancy Outcome (IPO) project. Using linked birth and infant death-certificate data, and IPO program records from a four-year period (1985-1988), this study compares the neonatal mortality rates of participants of Florida's IPO program with those of a matched comparison group. The results indicate an inverse relationship between IPO participation and the risk of neonatal mortality in a low-income population. These findings suggest that large-scale prenatal care programs can be effective in improving birth outcomes.

Medicaid costs and birth outcomes: the effects of prenatal WIC participation and the use of prenatal care

This study examines the effects of prenatal WIC participation and the use of prenatal care on Medicaid costs and birth outcomes in five states--Florida, Minnesota, North Carolina, South Carolina, and Texas. The study period is 1987 for Florida, Minnesota, North Carolina, and South Carolina and January-June 1988 for Texas. Prenatal WIC participation was associated with substantial savings in Medicaid costs during the first 60 days after birth, with estimates ranging from $277 in Minnesota to $598 in North Carolina. For every dollar spent on the prenatal WIC program, the associated savings in Medicaid costs during the first 60 days ranged from $1.77 to $3.13 across the five states. Receiving inadequate levels of prenatal care was associated with increases in Medicaid costs ranging from $210 in Florida to $1,184 in Minnesota. Prenatal WIC participation was associated with higher newborn birthweight, while receiving inadequate prenatal care was associated with lower birthweight.

The cost of maternal cocaine abuse: I. Perinatal cost

Although the clinical impact of maternal cocaine abuse has been well documented in recent years, there have been no reports on the direct and indirect costs of such abuse. This study compares hospital charges of a cocaine-abusing population with those of a control group. Ninety-one mother-infant pairs testing positive for cocaine at delivery were compared with a screened drug-free control population matched for socioeconomic status, age, and parity. When compared with controls, cocaine-positive mothers were more likely to deliver prematurely (37 versus 2%) and to have low birth weight (2613 versus 3340 g) or growth-retarded infants (12 versus 0%) with Apgar scores less than 7 at 5 minutes (8 versus 1%), signs of cocaine exposure (63 versus 0%), neonatal intensive care use (30 versus 3%), and extensive hospitalization (11 versus 3 days). As expected, there was a substantial cost difference between the study and control groups. Hospital charges for the labor, delivery, and postpartum care of cocaine-positive mothers in the study group averaged $3608, whereas maternal control charges averaged $3147 (P less than .05). Neonatal charges from the cocaine-positive study group averaged $13,222, whereas control charges averaged only $1297 (P less than .03). Most of the statistically significant differences in perinatal cost between the cocaine-positive and control populations can be traced to the association between cocaine abuse and premature birth. This information should benefit institutions and organizations trying to assess cost-benefit aspects of programs for prevention and treatment of cocaine abuse during pregnancy.

A comparison of Medicaid and non-Medicaid obstetrical care in California

The use of prenatal care and rates of low birth weight were examined among four groups of women who delivered in California in October 1983. Medicaid paid for the deliveries of two groups, and two groups were not so covered. The analyses suggest that longer Medicaid enrollment improved the use of prenatal care. The association between prenatal care and birth weight was less clear. For women under Medicaid, measures of infant and maternal morbidity, hospital characteristics, and Medicaid eligibility were all statistically related to charges, payments, and length of stay for the delivery hospitalization.

[A socioeconomic evaluation of the delivery of "Purita" milk to pregnant women in Chile]

A cost-effectiveness socio-economic evaluation of powdered milk delivery in Chile is presented. This 26% fat powdered milk is distributed free of cost to underweight pregnant women through primary health care services technically dependent on the Ministry of Health. A previous pilot study allowed to estimate the change in birth weight distribution associated to the absence of this milk supplementation program. The expected infant mortality rates and health care costs that would follow suggest that the milk supplementation program saves about $10 per infant.

A time-series analysis of unemployment and health. The case of birth outcomes in New York City

The paper presents an aggregate time-series analysis of unemployment and infant health that improves on previous work in several ways. First, the data is monthly as opposed to annual. Second, the measure of health, the percentage of low-birthweight births, and the health inputs are race-specific. Third, because a pregnancy is limited to at most ten months, we can specify a lag length with a greater degree of confidence. We find no cyclical variation in the percentage of low-birthweight births. The results are insensitive to changes in lag length, health inputs, and functional form.

No cure, no pay: an acceptable way of financing fertility treatments?

Recently three cost-effectiveness studies in health care have been carried out with the explicit goal to support reimbursement policy. The authors of this article were the main researchers for one of these studies: a cost-effectiveness analysis on in vitro fertilization. After the most important conclusions of the study are summarized, possible and impossible regulatory options for IVF and for other fertility treatments are discussed. Finally, these options are related to the actual decisions that have been made since the end of this study.