The West Los Angeles Preterm Birth Prevention Project: II. Cost-effectiveness analysis of high-risk pregnancy interventions

OBJECTIVE

To examine the cost-effectiveness of the West Los Angeles Preterm Birth Prevention Project.

METHODS

Maternal and neonatal care data were collected on all preterm deliveries (150) and a random sample of term deliveries (140) from high-risk patients at both experimental and control clinic sites. Costs were determined for prenatal care, inpatient preterm labor, delivery and postpartum care, and newborn care. Cost calculations, weighted by the actual proportions of term and preterm births, were confirmed with square-root transformation and trimmed mean (2%) values.

RESULTS

When compared to control clinic high-risk patients, experimental clinic high-risk patients had an average cost savings of $2196 for newborn care (P = .02), resulting in a net savings of $1768 per high-risk mother-infant pair. Births before 32 weeks' gestation accounted for the greatest mean cost.

CONCLUSION

Programs of comprehensive prenatal care and patient education may be highly cost-effective for prevention of prematurity.

The West Los Angeles Preterm Birth Prevention Project. I. Program impact on high-risk women

OBJECTIVE

The primary objective of this prospective study was to test whether preterm birth prevention education plus increased clinic visits and selected prophylactic interventions reduce preterm birth.

STUDY DESIGN

Eight West Los Angeles prenatal county clinics, comparable with respect to selected demographics, were randomized to be either experimental or control clinics. High-risk patients in all clinics were identified with a risk scoring system derived from a similar population. High-risk patients (N = 1774) in experimental clinics were offered a program of education and more frequent visits and were randomized to receive various secondary intervention protocols in addition to the basic interventions of education and more frequent visits. Control clinic patients (N = 880) received standard county care.

RESULTS

Preterm birth rates were 19% lower among the experimental high-risk patients (7.4% vs 9.1%), and differences were significant (p < 0.05) when preterm risk was taken into account. There was no evidence to suggest that the secondary interventions provided added benefit over the primary intervention protocol of preterm birth prevention education and increased visits.

CONCLUSION

The 19% reduction in preterm birth rate observed in the experimental clinics suggest an overall program benefit from a protocol that offered education, more frequent visits, and greater attention given to patients while the selected interventions were applied.

A simplified risk-scoring system for prematurity

Prematurity, the major cause of perinatal morbidity and mortality, results from a multifactorial interaction of medical, historic, and psychosocial conditions. Although the literature contains several reports of prematurity risk-scoring systems, the relative importance of specific risk factors may depend on the population studied. This report represents the first prematurity risk-scoring system designed specifically for a predominantly Hispanic population in the United States. Retrospective analysis of 8240 births occurring at Harbor/UCLA Medical Center from July, 1979 to December, 1982 identified maternal prenatal risk factors that were found to be statistically related to prematurity. A linear logistic regression model was then employed to derive a composite risk score. Using the logistic risk scores, we developed a simplified model for identifying women at risk for preterm birth. The methodology and analyses provide a system for the development of population-specific risk scoring.