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Abel L, Quaife M. A Pregnant Pause: Rethinking Economic Evaluation in Contraception and Pregnancy. Value Health 2022; 25:32-35. [PMID: 35031097 DOI: 10.1016/j.jval.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/03/2021] [Indexed: 06/14/2023]
Abstract
Pregnancy presents a unique challenge to economic evaluation, requiring methods that can account for both maternal and fetal outcomes. The ethical challenges to healthcare presented by pregnancy are well understood, but these have not yet been incorporated into cost-effectiveness approaches. Economic evaluations of pregnancy currently take an ad hoc approach to outcome valuation, opening the door to biased estimates and inconsistent resource allocation. We summarize the limitations of current economic evaluation methods and outline key areas for future work.
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Affiliation(s)
- Lucy Abel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK.
| | - Matthew Quaife
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England, UK
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Akobirshoev I, Mitra M, Parish SL, Valentine A, Simas TAM. Racial and Ethnic Disparities in Birth Outcomes and Labor and Delivery Charges Among Massachusetts Women With Intellectual and Developmental Disabilities. Intellect Dev Disabil 2020; 58:126-138. [PMID: 32240049 DOI: 10.1352/1934-9556-58.2.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Understanding the pregnancy experiences of racial and ethnic minority women with intellectual and developmental disabilities (IDD) is critical to ensuring that policies can effectively support these women. This research analyzed data from the 1998-2013 Massachusetts Pregnancy to Early Life Longitudinal (PELL) data system to examine the racial and ethnic disparities in birth outcomes and labor and delivery charges of U.S. women with IDD. There was significant preterm birth disparity among non-Hispanic Black women with IDD compared to their non-Hispanic White peers. There were also significant racial and ethnic differences in associated labor and delivery-related charges. Further research, examining potential mechanisms behind the observed racial and ethnic differences in labor and delivery-related charges in Massachusetts' women with IDD is needed.
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Affiliation(s)
- Ilhom Akobirshoev
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
| | - Monika Mitra
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
| | - Susan L Parish
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
| | - Anne Valentine
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
| | - Tiffany A Moore Simas
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
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Le KD, Nguyen LK, Nguyen LTM, Mol BWJ, Dang VQ. Cervical pessary vs vaginal progesterone for prevention of preterm birth in women with twin pregnancy and short cervix: economic analysis following randomized controlled trial. Ultrasound Obstet Gynecol 2020; 55:339-347. [PMID: 31432562 DOI: 10.1002/uog.20848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/01/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the cost-effectiveness of cervical pessary vs vaginal progesterone to prevent preterm birth and neonatal morbidity in women with twin pregnancy and a short cervix. METHODS Between 4 March 2016 and 3 June 2017, we performed this economic analysis following a randomized controlled trial (RCT), performed at My Duc Hospital, Ho Chi Minh City, Vietnam, that compared cervical pessary to vaginal progesterone in women with twin pregnancy and cervical length < 38 mm between 16 and 22 weeks of gestation. We used morbidity-free neonatal survival as a measure of effectiveness. Data on pregnancy outcome, maternal morbidity and neonatal complications were collected prospectively from medical files; additional information was obtained via telephone interviews with the patients. The incremental cost-effectiveness ratio was calculated as the incremental cost required to achieve one extra surviving morbidity-free neonate in the pessary group compared with in the progesterone group. Probabilistic and one-way sensitivity analyses were also performed. RESULTS During the study period, we screened 1113 women with twin pregnancy, of whom 300 fulfilled the inclusion criteria of the RCT and gave informed consent to participate. These women were assigned randomly to receive cervical pessary (n = 150) or vaginal progesterone (n = 150), with two women and one woman, respectively, being lost to follow-up. The rate of morbidity-free neonatal survival was significantly higher in the pessary group compared with the progesterone group (n = 241/296 (81.4%) vs 219/298 (73.5%); relative risk, 1.11 (95% CI, 1.02-1.21), P = 0.02). The mean total cost per woman was 3146 € in the pessary group vs 3570 € in the progesterone group (absolute difference, -424 € (95% CI, -842 to -3 €), P = 0.048). The cost per morbidity-free neonate was significantly lower in the pessary group compared with that in the progesterone group (2492 vs 2639 €; absolute difference, -147 € (95% CI, -284 to 10 €), P = 0.035). CONCLUSION In women with twin pregnancy and a short cervix, cervical pessary improves significantly the rate of morbidity-free neonatal survival while reducing costs, as compared with vaginal progesterone. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- K D Le
- HOPE Research Center, Ho Chi Minh City, Vietnam
| | - L K Nguyen
- My Duc Hospital, Ho Chi Minh City, Vietnam
| | | | - B W J Mol
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia
| | - V Q Dang
- HOPE Research Center, Ho Chi Minh City, Vietnam
- My Duc Hospital, Ho Chi Minh City, Vietnam
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Mrejen M, Machado DC. In utero exposure to economic fluctuations and birth outcomes: An analysis of the relevance of the local unemployment rate in Brazilian state capitals. PLoS One 2019; 14:e0223673. [PMID: 31600322 PMCID: PMC6786569 DOI: 10.1371/journal.pone.0223673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/25/2019] [Indexed: 11/30/2022] Open
Abstract
Objective Analyze if in utero exposure to economic downturns is associated with worsened birth outcomes. Methods We used birth records from all live singleton births in the 27 Brazilian state capitals between October 2012 and December 2016 (n = 2,952,430) and linked them to local unemployment rates according to the mother’s residence. We estimated the association between different birth outcomes and the local unemployment rate in the three trimesters before birth. We included maternal characteristics and month, year and municipality fixed effects as covariates. We also estimated the association for different groups of mothers, based on marital status, educational level, age and race. Results A 1 p.p. increase in the local unemployment rate in the trimester before birth is associated with 2.68% higher odds of being born with very low birthweight (< 1500 grams) (OR: 1.0268, 95% CI: 1.0006–1.0536). That result is pushed by the effect among newborns from mothers younger than 24 (OR: 1.0684, 95%CI: 1.0353–1.1024), from mothers with 11 years of schooling or less (OR: 1.0477, 95% CI: 1.0245–1.0714), and from brown or black mothers (OR: 1.0387, 95%CI: 1.0156–1.0624). The associations among children born from younger, less educated and black or brown mothers are robust to the application of a procedure to control for multiple testing, albeit the results considering the whole sample are not. Conclusions Our study shows that there is an association between in utero exposure to higher unemployment rates during the last gestational trimester and the odds of being born with VLBW among children born from mothers younger than 24 years old, with less of 11 years of education and black or brown. These results suggest that children born from women of low socioeconomic status are more vulnerable to in utero exposure to economic downturns.
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Affiliation(s)
- Matias Mrejen
- Department of Economics, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
- * E-mail:
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Abstract
INTRODUCTION Low birth weight (LBW) is an important indicator of the healthy of the population and reflects the living conditions, health and health behaviours of pregnant women. OBJECTIVE To assess the relationship between Gross Enrollment Rate at the Tertiary Education Level, average salary, Gross Domestic Product per capita, unemployment, housing area, urbanization and low birth weight in Polish sub-regions. MATERIAL AND METHODS An ecological study was undertaken using data on socio-economic and demographic features and LBW in 2005-2014. The units of observation were 66 Polish sub-regions according to the NUTS-3 classification. Two models were used to assess the influence of SES variables on LBW incidence rate in a 10-year study period. The first was the Poisson regression model adjusted for density of population, which was followed by the multivariable model using the GEE method of model parameters estimation. RESULTS In Poland, significant slow changes in the LBW incidence rate were observed in 2005-2014 (AAPC = -0.44%/year). In model 1, the increase in LBW was associated with an increase in unemployment (1.005) and decrease of average salary (0.987), GERTEL (0.990) and housing area (0.991). In model 2, an unfavorable association was detected between the density of population (1.068) and a still existing relationship with unemployment (1.004), average salary (0.990) and GERTEL (0.991). CONCLUSIONS Protective factors for newborns' health were a higher level of education and income. The results indicate the need to take actions to reduce the risk factors of LBW among pregnant women living in densely populated areas.
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Rosales-Rueda M. The impact of early life shocks on human capital formation: evidence from El Niño floods in Ecuador. J Health Econ 2018; 62:13-44. [PMID: 30268992 DOI: 10.1016/j.jhealeco.2018.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 02/27/2018] [Accepted: 07/07/2018] [Indexed: 06/08/2023]
Abstract
This paper investigates the persistent effects of negative shocks in utero and in infancy on low-income children's health and cognitive outcomes and examines whether timing of exposure matters differentially by skill type. Specifically, I exploit the geographic intensity of extreme floods in Ecuador during the 1997-1998 El Niño phenomenon, which provides exogenous variation in exposure at different periods of early development. I show that children exposed to severe floods in utero, especially during the third trimester, are shorter in stature five and seven years later. Also, children affected by the floods in the first trimester of pregnancy score lower on cognitive tests. Additionally, I explore potential mechanisms by studying health at birth and family inputs (income, consumption, and breastfeeding). I find that children exposed to El Niño floods, especially during the third trimester in utero, were more likely to be born with low birth weight. Furthermore, households affected by El Niño suffered a decline in income, total consumption, and food consumption in the aftermath of the shock. Falsification exercises and robustness checks suggest that selection concerns such as selective fertility, mobility, and infant mortality do not drive these results.
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Affiliation(s)
- Maria Rosales-Rueda
- Rutgers University, Department of Economics, 360 Martin Luther King Jr. Blvd Newark, NJ 07102, United States.
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Margerison-Zilko CE, Li Y, Luo Z. Economic Conditions During Pregnancy and Adverse Birth Outcomes Among Singleton Live Births in the United States, 1990-2013. Am J Epidemiol 2017; 186:1131-1139. [PMID: 29036485 DOI: 10.1093/aje/kwx179] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/09/2017] [Indexed: 12/20/2022] Open
Abstract
We know little about the relationship between the macroeconomy and birth outcomes, in part due to the methodological challenge of distinguishing effects of economic conditions on fetal health from effects of economic conditions on selection into live birth. We examined associations between state-level unemployment rates in the first 2 trimesters of pregnancy and adverse birth outcomes, using natality data on singleton live births in the United States during 1990-2013. We used fixed-effect logistic regression models and accounted for selection by adjusting for state-level unemployment before conception and maternal characteristics associated with both selection and birth outcomes. We also tested whether associations between macroeconomic conditions and birth outcomes differed during and after (compared with before) the Great Recession (2007-2009). Each 1-percentage-point increase in the first-trimester unemployment rate was associated with a 5% increase in odds of preterm birth, while second-trimester unemployment was associated with a 3% decrease in preterm birth odds. During the Great Recession, however, first-trimester unemployment was associated with a 16% increase in odds of preterm birth. These findings increase our understanding of the effects of the Great Recession on health and add to growing literature suggesting that macro-level social and economic factors contribute to perinatal health.
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Scriven PN. Towards a better understanding of preimplantation genetic screening for aneuploidy: insights from a virtual trial for women under the age of 40 when transferring embryos one at a time. Reprod Biol Endocrinol 2017; 15:49. [PMID: 28666459 PMCID: PMC5493873 DOI: 10.1186/s12958-017-0269-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/21/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The aim of this theoretical study is to explore the cost-effectiveness of aneuploidy screening in a UK setting for every woman aged under the age of 40 years when fresh and vitrified-warmed embryos are transferred one at a time in a first full cycle of assisted conception. METHODS It is envisaged that a 24-chromosome genetic test for aneuploidy could be used to exclude embryos with an abnormal test result from transfer, or used only to rank embryos with the highest potential to be viable; the effect on cumulative outcome is assessed. The cost associated with one additional live birth event and one clinical miscarriage avoided is estimated, and the time taken to complete a cycle considered. The numbers of individual woman for whom testing is likely to be beneficial or detrimental is also evaluated. RESULTS Adding aneuploidy screening to a first treatment cycle is unlikely to result in a higher chance of a live birth event, and can be detrimental for some women. Premature termination of a clinical trial is likely to be biased in favour of genetic testing. Testing is likely to be an expensive way of reducing the chance of clinical miscarriage and shortening treatment time without a substantial reduction in the cost of testing, and is likely to benefit a minority of women. Selecting out embryos is likely to reduce the treatment time for women whether or not they have a baby, whilst ranking embryos only to reduce the time for those that have a child and not for those who need another stimulated cycle. CONCLUSIONS Adding aneuploidy screening to IVF treatment for women under the age of 40 years is unlikely to be beneficial for most women. To achieve an unbiased assessment of the cost-effectiveness of genetic testing for aneuploidy, clinical trials need to take account of women who still have embryos available for transfer at the end of the study period. Specifying the proportions of women for whom testing is likely to be beneficial and detrimental may help better inform couples who might be considering adding aneuploidy screening to their treatment cycle.
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Affiliation(s)
- Paul N Scriven
- Genetics Laboratories, 5th Floor Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.
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Dills AK, Grecu AM. Effects of state contraceptive insurance mandates. Econ Hum Biol 2017; 24:30-42. [PMID: 27889633 DOI: 10.1016/j.ehb.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 06/06/2023]
Abstract
Using U.S. Natality data for 1996 through 2009 and an event analysis specification, we investigate the dynamics of the effects of state insurance contraceptive mandates on births and measures of parental investment: prenatal visits, non-marital childbearing, and risky behaviors during pregnancy. We analyze outcomes separately by age, race, and ethnicity. Among young Hispanic women, we find a 4% decline in the birth rate. There is evidence of a decrease in births to single mothers, consistent with increased wantedness. We also find evidence of selection into motherhood, which could explain the lack of a significant effect on birth outcomes.
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Affiliation(s)
- Angela K Dills
- Western Carolina University, Forsyth 224A, Cullowhee, NC 28723, United States.
| | - Anca M Grecu
- Seton Hall University, JH 621 Department of Economics and Legal Studies, Stillman School of Business, Seton Hall University, 400 South Orange Ave, South Orange, NJ, 07079, United States.
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Shireman TI, Kerling EH, Gajewski BJ, Colombo J, Carlson SE. Docosahexaenoic acid supplementation (DHA) and the return on investment for pregnancy outcomes. Prostaglandins Leukot Essent Fatty Acids 2016; 111:8-10. [PMID: 27499448 PMCID: PMC4978141 DOI: 10.1016/j.plefa.2016.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 11/27/2022]
Abstract
The Kansas University DHA Outcomes Study (KUDOS) found a significant reduction in early preterm births with a supplement of 600mg DHA per day compared to placebo. The objective of this analysis was to determine if hospital costs differed between groups. We applied a post-hoc cost analysis of the delivery hospitalization and all hospitalizations in the following year to 197 mother-infant dyads who delivered at Kansas University Hospital. Hospital cost saving of DHA supplementation amounted to $1678 per infant. Even after adjusting for the estimated cost of providing 600mg/d DHA for 26 weeks ($166.48) and a slightly higher maternal care cost ($26) in the DHA group, the net saving per dyad was $1484. Extrapolating this to the nearly 4 million US deliveries per year suggests universal supplementation with 600mg/d during the last 2 trimesters of pregnancy could save the US health care system up to USD 6 billion.
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Affiliation(s)
- T I Shireman
- The Department of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - E H Kerling
- The Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - B J Gajewski
- The Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - J Colombo
- The Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - S E Carlson
- The Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA.
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Carpinello OJ, Casson PR, Kuo CL, Raj RS, Sills ES, Jones CA. Cost Implications for Subsequent Perinatal Outcomes After IVF Stratified by Number of Embryos Transferred: A Five Year Analysis of Vermont Data. Appl Health Econ Health Policy 2016; 14:387-395. [PMID: 26969653 DOI: 10.1007/s40258-016-0237-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND In states in the USA without in vitro fertilzation coverage (IVF) insurance coverage, more embryos are transferred per cycle leading to higher risks of multi-fetal pregnancies and adverse pregnancy outcomes. OBJECTIVE To determine frequency and cost of selected adverse perinatal complications based on number of embryos transferred during IVF, and calculate incremental cost per IVF live birth. METHODS Medical records of patients who conceived with IVF (n = 116) and delivered at >20 weeks gestational age between 2007 and 2011 were evaluated. Gestational age at delivery, low birth weight (LBW) term births, and delivery mode were tabulated. Healthcare costs per cohort, extrapolated costs assuming 100 patients per cohort, and incremental costs per infant delivered were calculated. RESULTS The highest prematurity and cesarean section rates were recorded after double embryo transfers (DET), while the lowest rates were found in single embryo transfers (SET). Premature singleton deliveries increased directly with number of transferred embryos [6.3 % (SET), 9.1 % (DET) and 10.0 % for ≥3 embryos transferred]. This trend was also noted for rate of cesarean delivery [26.7 % (SET), 36.6 % (DET), and 47.1 % for ≥3 embryos transferred]. The proportion of LBW infants among deliveries after DET and for ≥3 embryos transferred was 3.9 and 9.1 %, respectively. Extrapolated costs per cohort were US$718,616, US$1,713,470 and US$1,227,396 for SET, DET, and ≥3 embryos transferred, respectively. CONCLUSION Attempting to improve IVF pregnancy rates by permitting multiple embryo transfers results in sharply increased rates of multiple gestation and preterm delivery. This practice yields a greater frequency of adverse perinatal outcomes and substantially increased healthcare spending. Better efforts to encourage SET are necessary to normalize healthcare expenditures considering the frequency of very high cost sequela associated with IVF where multiple embryo transfers occur.
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Affiliation(s)
| | - Peter R Casson
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA
| | - Chia-Ling Kuo
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA
| | - Renju S Raj
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA
| | - E Scott Sills
- Reproductive Research Section, Center for Advanced Genetics, 3144 El Camino Real, Suite 106, Carlsbad, CA, 92008, USA.
- Department of Molecular and Applied Biosciences, University of Westminster, London, UK.
| | - Christopher A Jones
- Global Health Economics Unit of the Vermont Center for Clinical and Translational Science and Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA
- Center for Study of Multiple Births, Chicago, IL, USA
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Mogos MF, Araya WN, Masho SW, Salemi JL, Shieh C, Salihu HM. The Feto-Maternal Health Cost of Intimate Partner Violence Among Delivery-Related Discharges in the United States, 2002-2009. J Interpers Violence 2016; 31:444-464. [PMID: 25392375 DOI: 10.1177/0886260514555869] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Our purpose was to estimate the national prevalence of intimate partner violence (IPV) among delivery-related discharges and to investigate its association with adverse feto-maternal birth outcomes and delivery-related cost. A retrospective cross-sectional analysis of delivery-related hospital discharges from 2002 to 2009 was conducted using the Nationwide Inpatient Sample (NIS). We used ICD-9-CM codes to identify IPV, covariates, and outcomes. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between IPV and each outcome. Joinpoint regression was used for trend analysis. During the study period, 3,649 delivery-related discharges were diagnosed with IPV (11.2 per 100,000; 95% CI = [10.0, 12.4]). IPV diagnosis during delivery is associated with stillbirth (AOR = 4.12, 95% CI = [2.75, 6.17]), preterm birth (AOR = 1.97, 95% CI = [1.59, 2.44]), fetal death (AOR = 3.34, 95% CI = [1.99, 5.61]), infant with poor intrauterine growth (AOR = 1.55, 95% CI = [1.01, 2.40]), and increased inpatient hospital care cost (US$5,438.2 vs. US$4,080.1) per each discharge, incurring an additional cost of US$4,955,707 during the study period. IPV occurring during pregnancy has a significant health burden to both the mother and infant. Education about IPV; screening at periodic intervals, including during obstetric visits; and ongoing clinical care could help to reduce or eliminate adverse effects of pregnancy-related IPV. Preventing the lifelong consequences associated with IPV can have a positive effect on the overall health of all women and delivery-related health care cost.
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Affiliation(s)
| | | | - Saba W Masho
- Virginia Commonwealth University, Richmond, VA, USA
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Abstract
This paper evaluates the impact of state-level Medicaid reimbursement rates for obstetric care on prenatal care utilization across demographic groups. It also uses these rates as an instrumental variable to assess the importance of prenatal care on birth weight. The analysis is conducted using a unique dataset of Medicaid reimbursement rates and 2001-2010 Vital Statistics Natality data. Conditional on county fixed effects, the study finds a modest, but statistically significant positive relationship between Medicaid reimbursement rates and the number of prenatal visits obtained by pregnant women. Additionally, higher rates are associated with an increase in the probability of obtaining adequate care, as well as a reduction in the incidence of going without any prenatal care. However, the effect of an additional prenatal visit on birth weight is virtually zero for black disadvantaged mothers, while an additional visit yields a substantial increase in birth weight of over 20 g for white disadvantaged mothers.
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Affiliation(s)
- Lyudmyla Sonchak
- SUNY Oswego, Department of Economics, 425 Mahar Hall, Oswego, NY 13126, United States.
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Whiteman VE, Salemi JL, Mejia De Grubb MC, Ashley Cain M, Mogos MF, Zoorob RJ, Salihu HM. Additive effects of Pre-pregnancy body mass index and gestational diabetes on health outcomes and costs. Obesity (Silver Spring) 2015; 23:2299-308. [PMID: 26390841 DOI: 10.1002/oby.21222] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/11/2015] [Accepted: 06/19/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Pre-pregnancy obesity and gestational diabetes mellitus (GDM) are increasingly prevalent independent risk factors for maternal and infant morbidities. However, there is a paucity of information on their joint effects on health outcomes and healthcare costs. METHODS A population-based retrospective cohort study was conducted in Florida using a validated statewide database covering 1,057,647 infants born between 2004 and 2009. Using generalized linear modeling, joint associations between levels of pre-pregnancy body mass index (BMI) and GDM and maternal complications of pregnancy, adverse birth outcomes, and healthcare costs were examined. The relative excess risk due to interaction was used to describe the direction and magnitude of the BMI-GDM interaction on the additive scale. RESULTS Increasing pre-pregnancy BMI conferred increasing odds of adverse consequences, as did GDM, and the BMI-GDM interaction was greater than additive for 9 of 14 outcomes. The cost for infants born to women with GDM/obesity-III was 34% higher during the first year compared with those born to women with normal BMI and without GDM. The costs of maternal and infant inpatient care associated with overweight/obesity and GDM totaled over $351 million. CONCLUSIONS These findings provide further evidence of the importance of lifestyle modifications to decrease rates of obesity and risk factors from GDM.
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Affiliation(s)
- Valerie E Whiteman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Maria C Mejia De Grubb
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Mary Ashley Cain
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Mulubrhan F Mogos
- Department of Community and Health Systems, School of Nursing, University of Indiana, Indianapolis, Indiana, USA
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Hamisu M Salihu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
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Jovanovič L, Liang Y, Weng W, Hamilton M, Chen L, Wintfeld N. Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy. Diabetes Metab Res Rev 2015; 31:707-16. [PMID: 25899622 PMCID: PMC4676929 DOI: 10.1002/dmrr.2656] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 04/15/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increasing diabetes prevalence affects a substantial number of pregnant women in the United States. Our aims were to evaluate health outcomes, medical costs, risks and types of complications associated with diabetes in pregnancy for mothers and newborns. METHODS In this retrospective claims analysis, patients were identified from the Truven Health MarketScan(®) database (2004-2011 inclusive). Participants were aged 18-45 years, with ascertainable diabetes status [Yes/No], date of birth event >2005 and continuous health plan enrolment ≥21 months before and 3 months after the birth. RESULTS In total, 839 792 pregnancies were identified, and 66 041 (7.86%) were associated with diabetes mellitus [type 1 (T1DM), 0.13%; type 2 (T2DM), 1.21%; gestational (GDM), 6.29%; and GDM progressing to T2DM (patients without prior diabetes who had a T2DM diagnosis after the birth event), 0.23%]. Relative risk (RR) of stillbirth (2.51), miscarriage (1.28) and Caesarean section (C-section) (1.77) was significantly greater with T2DM versus non-diabetes. Risk of C-section was also significantly greater for other diabetes types [RR 1.92 (T1DM); 1.37 (GDM); 1.63 (GDM progressing to T2DM)]. Risk of overall major congenital (RR ≥ 1.17), major congenital circulatory (RR ≥ 1.19) or major congenital heart (RR ≥ 1.18) complications was greater in newborns of mothers with diabetes versus without. Mothers with T2DM had significantly higher risk (RR ≥ 1.36) of anaemia, depression, hypertension, infection, migraine, or cardiac, obstetrical or respiratory complications than non-diabetes patients. Mean medical costs were higher with all diabetes types, particularly T1DM ($27 531), than non-diabetes ($14 355). CONCLUSIONS Complications and costs of healthcare were greater with diabetes, highlighting the need to optimize diabetes management in pregnancy.
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MESH Headings
- Abortion, Spontaneous/economics
- Abortion, Spontaneous/epidemiology
- Adolescent
- Adult
- Anemia/economics
- Anemia/epidemiology
- Cesarean Section/economics
- Cesarean Section/statistics & numerical data
- Congenital Abnormalities/economics
- Congenital Abnormalities/epidemiology
- Depression/economics
- Depression/epidemiology
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 2/economics
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes, Gestational/economics
- Diabetes, Gestational/epidemiology
- Female
- Health Care Costs
- Heart Defects, Congenital/economics
- Heart Defects, Congenital/epidemiology
- Humans
- Incidence
- Infant, Newborn
- Middle Aged
- Pregnancy
- Pregnancy Complications, Cardiovascular/economics
- Pregnancy Complications, Cardiovascular/epidemiology
- Pregnancy Complications, Hematologic/economics
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Complications, Infectious/economics
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Outcome/economics
- Pregnancy Outcome/epidemiology
- Pregnancy in Diabetics/economics
- Pregnancy in Diabetics/epidemiology
- Retrospective Studies
- Stillbirth/economics
- Stillbirth/epidemiology
- United States
- Young Adult
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Affiliation(s)
- Lois Jovanovič
- Sansum Diabetes Research InstituteSanta Barbara, CA, USA
- * Correspondence to: Lois Jovanovič, Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA, 93105 USA., E-mail:
| | | | | | | | - Lisa Chen
- Novo Nordisk Inc.Plainsboro, NJ, USA
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16
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Abstract
BACKGROUND Pre-eclampsia is a pregnancy complication affecting both mother and fetus. Although there is no proven effective method to prevent pre-eclampsia, early identification of women at risk of pre-eclampsia could enhance appropriate application of antenatal care, management and treatment. Very little is known about the cost effectiveness of these and other tests for pre-eclampsia, mainly because there is no clear treatment path. The aim of this study was to provide a comprehensive overview of the existing evidence on the health economics of screening, diagnosis and treatment options in pre-eclampsia. METHODS We searched three electronic databases (PubMed, EMBASE and the Cochrane Library) for studies on screening, diagnosis, treatment or prevention of pre-eclampsia, published between 1994 and 2014. Only full papers written in English containing complete economic assessments in pre-eclampsia were included. RESULTS From an initial total of 138 references, six papers fulfilled the inclusion criteria. Three studies were on the cost effectiveness of treatment of pre-eclampsia, two of which evaluated magnesium sulphate for prevention of seizures and the third evaluated the cost effectiveness of induction of labour versus expectant monitoring. The other three studies were aimed at screening and diagnosis, in combination with subsequent preventive measures. The two studies on magnesium sulphate were equivocal on the cost effectiveness in non-severe cases, and the other study suggested that induction of labour in term pre-eclampsia was more cost effective than expectant monitoring. The screening studies were quite diverse in their objectives as well as in their conclusions. One study concluded that screening is probably not worthwhile, while two other studies stated that in certain scenarios it may be cost effective to screen all pregnant women and prophylactically treat those who are found to be at high risk of developing pre-eclampsia. DISCUSSION This study is the first to provide a comprehensive overview on the economic aspects of pre-eclampsia in its broadest sense, ranging from screening to treatment options. The main limitation of the present study lies in the variety of topics in combination with the limited number of papers that could be included; this restricted the comparisons that could be made. In conclusion, novel biomarkers in screening for and diagnosing pre-eclampsia show promise, but their accuracy is a major driver of cost effectiveness, as is prevalence. Universal screening for pre-eclampsia, using a biomarker, will be feasible only when accuracy is significantly increased.
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Affiliation(s)
- Neily Zakiyah
- Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Maarten J Postma
- Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
- Health Technology Assessment Unit, Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Philip N Baker
- Institute of Science and Technology in Medicine, Keele University, Staffordshire, UK
| | - Antoinette D I van Asselt
- Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
- Health Technology Assessment Unit, Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands.
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Powell-Jackson T, Mazumdar S, Mills A. Financial incentives in health: New evidence from India's Janani Suraksha Yojana. J Health Econ 2015; 43:154-69. [PMID: 26302940 DOI: 10.1016/j.jhealeco.2015.07.001] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 06/19/2015] [Accepted: 07/10/2015] [Indexed: 05/05/2023]
Abstract
This paper studies the health effects of one of the world's largest demand-side financial incentive programmes--India's Janani Suraksha Yojana. Our difference-in-difference estimates exploit heterogeneity in the implementation of the financial incentive programme across districts. We find that cash incentives to women were associated with increased uptake of maternity services but there is no strong evidence that the JSY was associated with a reduction in neonatal or early neonatal mortality. The positive effects on utilisation are larger for less educated and poorer women, and in places where the cash payment was most generous. We also find evidence of unintended consequences. The financial incentive programme was associated with a substitution away from private health providers, an increase in breastfeeding and more pregnancies. These findings demonstrate the potential for financial incentives to have unanticipated effects that may, in the case of fertility, undermine the programme's own objective of reducing mortality.
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Affiliation(s)
| | | | - Anne Mills
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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18
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Amaral-Garcia S, Bertoli P, Grembi V. Does Experience Rating Improve Obstetric Practices? Evidence from Italy. Health Econ 2015; 24:1050-1064. [PMID: 26095679 DOI: 10.1002/hec.3210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 06/04/2023]
Abstract
Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. Our identification strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in-differences analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. We find that the increase in medical malpractice pressure is associated with a decrease in the probability of performing a C-section from 2.3 to 3.7 percentage points (7-11.6%) with no consequences for medical complications or neonatal outcomes. The impact can be explained by a reduction in the discretion of obstetric decision-making rather than by patient cream skimming.
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Affiliation(s)
| | - Paola Bertoli
- University of Economics, Prague, CERGE-EI, Prague, Czech Republic
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19
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Walters D, Gupta A, Nam AE, Lake J, Martino F, Coyte PC. A Cost-Effectiveness Analysis of Low-Risk Deliveries: A Comparison of Midwives, Family Physicians and Obstetricians. Healthc Policy 2015; 11:61-75. [PMID: 26571469 PMCID: PMC4748366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To investigate the cost-effectiveness of in-hospital obstetrical care by obstetricians (OBs), family physicians (FPs) and midwives (MWs) for delivery of low-risk obstetrical patients. METHODS Cost-effectiveness analysis from the Ministry of Health perspective using a retrospective cohort study. The time horizon was from hospital admission of a low-risk pregnant patient to the discharge of the mother and infant. Costing data included human resource, intervention and hospital case-mix costs. Interventions measured were induction or augmentation of labour with oxytocin, epidural use, forceps or vacuum delivery and caesarean section. The outcome measured was avoidance of transfer to a neonatal intensive care unit (NICU). Model results were tested using various types of sensitivity analyses. FINDINGS The mean maternal age by provider groups was 29.7 for OBs, 29.8 for FPs and 31.2 for MWs - a statistically higher mean for the MW group. The MW deliveries had lower costs and better outcomes than FPs and OBs. FPs also dominated OB.s The differences in cost per delivery were small, but slightly lower in MW ($5,102) and FP ($5,116) than in OB ($5,188). Avoidance of transfer to an NICU was highest for MW at 94.0% (95% CI: 91.0-97.0), compared with 90.2% for FP (95% CI: 88.2-92.2) and 89.6% for OB (95% CI: 88.6-90.6). The cost-effectiveness of the MW group is diminished by increases in compensation, and the cost-effectiveness of the FP group is sensitive to changes in intervention rates and costs. CONCLUSIONS The MW strategy was the most cost-effective in this hospital setting. Given data limitations to further examine patient characteristics between groups, the overall conservative findings of this study support investments and better integration for MWs in the current system.
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Affiliation(s)
- Dylan Walters
- Student Fellow, Canadian Centre for Health Economics, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Archna Gupta
- Family Physician, Department of Family Medicine, Brampton Civic Hospital, Brampton, ON
| | - Austin E Nam
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Jennifer Lake
- Assistant Professor, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON
| | - Frank Martino
- Chief of Family Medicine, William Osler Health System, Brampton, ON
| | - Peter C Coyte
- Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
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20
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Rice S. Inside the gray zone. New treatments of questionable effectiveness pose cost, safety questions. Mod Healthc 2015; 45:12-14. [PMID: 25671913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
MESH Headings
- Clinical Trials as Topic/economics
- Clinical Trials as Topic/standards
- Cost-Benefit Analysis
- Decision Making
- Female
- Humans
- Infertility, Male/economics
- Infertility, Male/therapy
- Information Dissemination/methods
- Male
- Outcome and Process Assessment, Health Care/economics
- Outcome and Process Assessment, Health Care/methods
- Outcome and Process Assessment, Health Care/standards
- Patient Care Bundles/economics
- Patient Care Bundles/standards
- Patient Safety/economics
- Patient Safety/standards
- Pregnancy
- Pregnancy Outcome/economics
- Pregnancy Outcome/epidemiology
- Product Surveillance, Postmarketing/economics
- Product Surveillance, Postmarketing/standards
- Reimbursement Mechanisms/standards
- Reimbursement Mechanisms/trends
- Sperm Injections, Intracytoplasmic/economics
- Sperm Injections, Intracytoplasmic/standards
- Sperm Injections, Intracytoplasmic/statistics & numerical data
- Technology Assessment, Biomedical/economics
- Technology Assessment, Biomedical/standards
- United States
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21
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Wymer KM, Shih YCT, Plunkett BA. The cost-effectiveness of a trial of labor accrues with multiple subsequent vaginal deliveries. Am J Obstet Gynecol 2014; 211:56.e1-56.e12. [PMID: 24487008 DOI: 10.1016/j.ajog.2014.01.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/07/2014] [Accepted: 01/21/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to estimate costs and outcomes of subsequent trials of labor after cesarean delivery (TOLAC) compared with elective repeat cesarean deliveries (ERCD). STUDY DESIGN To compare TOLAC and ERCD, maternal and neonatal decision analytic models were built for each hypothetic subsequent delivery. We assumed that only women without previa would undergo TOLAC for their second delivery, that women with successful TOLAC would desire future TOLAC, and that women who chose ERCD would undergo subsequent ERCD. Main outcome measures were maternal and neonatal mortality and morbidity rates, direct costs, and quality-adjusted life years. Values were derived from the literature. One-way and Monte-Carlo sensitivity analyses were performed. RESULTS TOLAC was less costly and more effective for most models. A progression of decreasing incremental cost and increasing incremental effectiveness of TOLAC was found for maternal outcomes with increasing numbers of subsequent deliveries. This progression was also displayed among neonatal outcomes and was most prominent when neonatal and maternal outcomes were combined, with an incremental cost and effectiveness of -$4700.00 and .073, respectively, for the sixth delivery. Net-benefit analysis showed an increase in the benefit of TOLAC with successive deliveries for all outcomes. The maternal model of the second delivery was sensitive to cost of delivery and emergent cesarean delivery. Successive maternal models became more robust, with the models of the third-sixth deliveries sensitive only to cost of delivery. Neonatal models were not sensitive to any variables. CONCLUSION Although nearly equally effective relative to ERCD for the second delivery, TOLAC becomes less costly and more effective with subsequent deliveries.
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Affiliation(s)
- Kevin M Wymer
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | | | - Beth A Plunkett
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL.
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22
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Michaan N, Gil Y, Amzalag S, Laskov I, Lessing J, Many A. Perinatal outcome and financial impact of Eritrean and Sudanese refugees delivered in a tertiary hospital in Tel Aviv, Israel. Isr Med Assoc J 2014; 16:371-374. [PMID: 25059000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND A growing number of Eritrean and Sudanese refugees seek medical assistance in the labor and delivery ward of our facility. Providing treatment to this unique population is challenging since communication is limited and pregnancy follow-up is usually absent. OBJECTIVES To compare the perinatal outcome of refugees and Israeli parturients. METHODS The medical and financial records of all refugees delivered between May 2010 and April 2011 were reviewed. Perinatal outcome was compared to that of native Israeli controls. RESULTS During this period 254 refugees were delivered (2.3% of deliveries). Refugees were significantly younger and leaner. They had significantly more premature deliveries under 37 weeks (23 vs. 10, P = 0.029) and under 34 weeks gestation (9 vs. 2, P = 0.036) with more admissions to the neonatal intensive care unit (15 vs. 5, P = 0.038). Overall cesarean section rate was similar but refugees required significantly more urgent surgeries (97% vs. 53%, P = 0.0001). Refugees had significantly more cases of meconium and episiotomies but fewer cases of epidural analgesia. There were 2 intrauterine fetal deaths among refugees, compared to 13 of 11,239 deliveries during this time period (P = 0.036), as well as 7 pregnancy terminations following sexual assault during their escape. Sixty-eight percent of refugees had medical fees outstanding with a total debt of 2,656,000 shekels (US$ 767,250). CONCLUSIONS The phenomenon of African refugees giving birth in our center is of unprecedented magnitude and bears significant medical and ethical implications. Refugees proved susceptible to adverse perinatal outcomes compared to their Israeli counterparts. Setting a pregnancy follow-up plan could, in the long run, prevent adverse outcomes and reduce costs involved in treating this population.
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23
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Jarlenski M, Bleich SN, Bennett WL, Stuart EA, Barry CL. Medicaid enrollment policy increased smoking cessation among pregnant women but had no impact on birth outcomes. Health Aff (Millwood) 2014; 33:997-1005. [PMID: 24889949 PMCID: PMC4248559 DOI: 10.1377/hlthaff.2013.1167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cigarette smoking during pregnancy is an important cause of poor maternal and infant health outcomes in the population eligible for Medicaid. These outcomes may be avoided or attenuated by timely, high-quality prenatal care. Using data from the Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System for the period 2004-10, we examined the effects of two optional state Medicaid enrollment policies on smoking cessation, preterm birth, and having an infant who was small for gestational age. We used a natural experiment to compare outcomes before and after nineteen states adopted either of the two policies. The first policy, presumptive eligibility, permits women to receive prenatal care while their Medicaid application is pending. Its adoption led to a 7.7-percentage-point increase in smoking cessation but did not reduce adverse birth outcomes. The second policy, the unborn-child option, permits states to provide coverage to pregnant women who cannot document their citizenship or residency. Its adoption was not significantly associated with any of the three outcomes. The presumptive-eligibility enrollment policy will continue to be an important tool for promoting timely prenatal care and smoking cessation.
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Affiliation(s)
- Marian Jarlenski
- Marian Jarlenski recently completed doctoral studies in health policy and management at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland. In fall 2014 she will become an assistant professor of health policy and management at the Graduate School of Public Health, University of Pittsburgh, in Pennsylvania
| | - Sara N Bleich
- Sara N. Bleich is an associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health
| | - Wendy L Bennett
- Wendy L. Bennett is an assistant professor of medicine in the Division of General Internal Medicine, Johns Hopkins University School of Medicine, in Baltimore
| | - Elizabeth A Stuart
- Elizabeth A. Stuart is an associate professor of mental health and biostatistics at the Johns Hopkins Bloomberg School of Public Health
| | - Colleen L Barry
- Colleen L. Barry is an associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health
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24
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Mohanan M, Bauhoff S, La Forgia G, Babiarz KS, Singh K, Miller G. Effect of Chiranjeevi Yojana on institutional deliveries and neonatal and maternal outcomes in Gujarat, India: a difference-in-differences analysis. Bull World Health Organ 2014; 92:187-94. [PMID: 24700978 PMCID: PMC3949592 DOI: 10.2471/blt.13.124644] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 10/14/2013] [Accepted: 10/30/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the effect of the Chiranjeevi Yojana programme, a public-private partnership to improve maternal and neonatal health in Gujarat, India. METHODS A household survey (n = 5597 households) was conducted in Gujarat to collect retrospective data on births within the preceding 5 years. In an observational study using a difference-in-differences design, the relationship between the Chiranjeevi Yojana programme and the probability of delivery in health-care institutions, the probability of obstetric complications and mean household expenditure for deliveries was subsequently examined. In multivariate regressions, individual and household characteristics as well as district and year fixed effects were controlled for. Data from the most recent District Level Household and Facility Survey (DLHS-3) wave conducted in Gujarat (n = 6484 households) were used in parallel analyses. FINDINGS Between 2005 and 2010, the Chiranjeevi Yojana programme was not associated with a statistically significant change in the probability of institutional delivery (2.42 percentage points; 95% confidence interval, CI: -5.90 to 10.74) or of birth-related complications (6.16 percentage points; 95% CI: -2.63 to 14.95). Estimates using DLHS-3 data were similar. Analyses of household expenditures indicated that mean household expenditure for private-sector deliveries had either not fallen or had fallen very little under the Chiranjeevi Yojana programme. CONCLUSION The Chiranjeevi Yojana programme appears to have had no significant impact on institutional delivery rates or maternal health outcomes. The absence of estimated reductions in household spending for private-sector deliveries deserves further study.
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Affiliation(s)
- Manoj Mohanan
- Sanford School of Public Policy, Duke University, 302 Towerview Drive, Durham NC 27708, United States of America (USA)
| | | | | | | | - Kultar Singh
- Sambodhi Research and Communications Pvt Ltd, New Delhi, India
| | - Grant Miller
- School of Medicine and Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, USA
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25
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Abstract
To explore racial-ethnic disparities in adverse pregnancy outcomes among Medicaid recipients, and to estimate excess Medicaid costs associated with the disparities. Cross-sectional study of adverse pregnancy outcomes and Medicaid payments using data from Medicaid Analytic eXtract files on all Medicaid enrollees in fourteen southern states. Compared to other racial and ethnic groups, African American women tended to be younger, more likely to have a Cesarean section, to stay longer in the hospital and to incur higher Medicaid costs. African-American women were also more likely to experience preeclampsia, placental abruption, preterm birth, small birth size for gestational age, and fetal death/stillbirth. Eliminating racial disparities in adverse pregnancy outcomes (not counting infant costs), could generate Medicaid cost savings of $114 to $214 million per year in these 14 states. Despite having the same insurance coverage and meeting the same poverty guidelines for Medicaid eligibility, African American women have a higher rate of adverse pregnancy outcomes than White or Hispanic women. Racial disparities in adverse pregnancy outcomes not only represent potentially preventable human suffering, but also avoidable economic costs. There is a significant financial return-on-investment opportunity tied to eliminating racial disparities in birth outcomes. With the Affordable Care Act expansion of Medicaid coverage for the year 2014, Medicaid could be powerful public health tool for improving pregnancy outcomes.
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Affiliation(s)
- Shun Zhang
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
| | - Kathryn Cardarelli
- Department of Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Ruth Shim
- Department of Psychiatry, Morehouse School of Medicine, Atlanta, GA, USA
| | - Jiali Ye
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
| | - Karla L. Booker
- Division of Maternal-Child Health, Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - George Rust
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
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26
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Abstract
New proposals for the diagnosis of gestational diabetes (GDM), promulgated by the International Association of Diabetes and Pregnancy Study Groups (IADPSG), will substantially increase the number of women diagnosed with GDM. This will have an enormous impact on healthcare resources, diverting attention away from genuinely high risk diabetic pregnancies. Randomized trials in 'mild' GDM indicate that the main effects of treatment are a 2 %-3 % reduction in birth weight, fewer 'big babies', and less shoulder dystocia. However, these studies used different diagnostic criteria, and women diagnosed by the broader IADPSG criteria may not derive the same modest benefit. Modeling indicates a very high cost per QALY, unless later development of type 2 diabetes can be prevented. Far from producing consensus, the IADPSG suggestion has thrown sharply into focus the need to assess critically the risks, costs and benefits of adopting criteria that may pathologize a large number of otherwise normal pregnancies.
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Affiliation(s)
- Hélène Long
- Division of Endocrinology and Metabolism, Department of Medicine, Laval Health and Social Services Center, Laval, Québec, Canada
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27
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Garvey M. The national birth center study II: Research confirms low Cesarean rates and health care costs at birth centers. Midwifery Today Int Midwife 2013:40-68. [PMID: 23847895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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28
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Sullivan AE, Hopkins PN, Weng HY, Henry E, Lo JOT, Varner MW, Esplin MS. Delivery of monochorionic twins in the absence of complications: analysis of neonatal outcomes and costs. Am J Obstet Gynecol 2012; 206:257.e1-7. [PMID: 22284957 DOI: 10.1016/j.ajog.2011.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/05/2011] [Accepted: 12/19/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to estimate the optimal time to deliver uncomplicated monochorionic-diamnionic (MCDA) twins. STUDY DESIGN Data were retrospectively obtained from twin pregnancies from 2000 through 2009. The gestational week-specific prospective perinatal mortality risk was calculated. A cohort of MCDA twins with nonindicated deliveries was analyzed separately. Neonatal outcomes and costs were compared between MCDA twins with nonindicated deliveries born at specific weeks of gestation, and those born the subsequent week. RESULTS There were 5894 dichorionic-diamnionic twins and 1704 MCDA twins. After 28 weeks, the gestational week-specific prospective risk of perinatal mortality did not differ between groups. There were 948 MCDA twins with nonindicated deliveries. Until 37 weeks, the risk of severe neonatal morbidity, perinatal mortality, and hospital costs were greater for fetuses delivered compared to fetuses born in a subsequent week. CONCLUSION To optimize neonatal outcome and decrease hospital costs, MCDA twins should not be delivered <37 weeks unless medically indicated.
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Affiliation(s)
- Amy Elizabeth Sullivan
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
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29
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Gee RE, Johnson KA. Louisiana Birth Outcomes Initiative: improving birth outcomes with interventions before, during, and after pregnancy. J La State Med Soc 2012; 164:6-9. [PMID: 22533105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The costs of poor birth outcomes to the United States in both human and fiscal terms are large and a continuing concern. Louisiana has among the worst birth outcomes in our nation, which include preterm and low birth weight births, and maternal and infant mortality. In response to these poor birth outcomes, the Louisiana Department of Health and Hospitals is implementing a statewide, multi-faceted Birth Outcomes Initiative at the level of the secretary. The Birth Outcomes Initiative aims to adopt evidence-based and best practices along the continuum of care for women and infants. Of particular importance is ending all non-medically indicated deliveries prior to 39 weeks, administration of the hormone 17-hydroxyprogesterone to eligible women for prematurity prevention, optimal behavioral health counseling and referral for reproductive aged women, and ensuring optimal health for women between pregnancies. Opportunities exist to improve outcomes for primary care and obstetrical providers. Louisiana is the first state to aim at improving birth outcomes with interventions before, during, and after pregnancy.
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Affiliation(s)
- Rebekah E Gee
- Louisiana State University Schools of Public Health and Medicine, USA
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Abstract
Gordon Smith argues for more and better research in screening for pregnancy outcomes, using the example of previous trials in pre-eclampsia.
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Affiliation(s)
- Gordon C S Smith
- Department of Obstetrics and Gynaecology, Cambridge University, Cambridge, United Kingdom.
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Bijlenga D, Bonsel GJ, Birnie E. Eliciting willingness to pay in obstetrics: comparing a direct and an indirect valuation method for complex health outcomes. Health Econ 2011; 20:1392-406. [PMID: 20967891 DOI: 10.1002/hec.1678] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Revised: 07/16/2010] [Accepted: 08/31/2010] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To compare direct and indirect willingness to pay (WTP) elicitation methods in terms of feasibility, reliability, and comparability. The application is obstetrics, where always both a mother's and a child's health are at stake. METHODS An open-ended contingent valuation method (CVM) as a direct WTP elicitation method, and the discrete choice experiment (DCE) as an indirect WTP elicitation method. Vignettes to be valued were based on clinical patient data. Participants were 88 laypersons who received their questionnaires by postal mail. RESULTS The DCE task was completed faster (p=0.006) and was regarded easier (p<0.001) than the CVM task. Test-retest for CVM was substantial (ICC=0.76), and for DCE moderate (k=0.49). Female sex (p<0.001), age≥50 years (p=0.013), higher income (p<0.001), and higher education (p<0.001) were associated with higher WTP. Correlation between CVM and DCE was 0.79 (Kendall's Tau-b; p<0.001). The implied WTP as derived with DCE was between 2.3 and 10.2 times higher than with CVM. The relationship between the WTPs was linear. CONCLUSION It is yet unclear what lies behind the numbers of DCE. DCE has no methodological benefits over the conventional CVM when eliciting WTP for complex health outcomes in obstetrics.
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Affiliation(s)
- Denise Bijlenga
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Garrouste C, Le J, Maurin E. The choice of detecting Down syndrome: does money matter? Health Econ 2011; 20:1073-1089. [PMID: 21671303 DOI: 10.1002/hec.1762] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 04/15/2011] [Accepted: 05/05/2011] [Indexed: 05/30/2023]
Abstract
The prenatal diagnosis of Down syndrome (amniocentesis) presents parents with a complex dilemma which requires comparing the risk of giving birth to an affected child and the risk of losing an unaffected child through amniocentesis-related miscarriage. Building on the specific features of the French Health insurance system, this paper shows that variation in the monetary costs of the diagnosis procedure may have a very significant impact on how parents solve this ethical dilemma. The French institutions make it possible to compare otherwise similar women facing very different reimbursement schemes and we find that eligibility to full reimbursement has a largely positive effect on the probability of taking an amniocentesis test. By contrast, the sole fact of being labelled 'high-risk' by the Health system seems to have, as such, only a modest effect on subsequent choices. Finally, building on available information on post-amniocentesis outcomes, we report new evidence suggesting that amniocentesis increases the risk of premature birth and low weight at birth.
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MESH Headings
- Abortion, Induced
- Abortion, Spontaneous/etiology
- Adult
- Amniocentesis/adverse effects
- Amniocentesis/economics
- Amniocentesis/standards
- Chorionic Gonadotropin, beta Subunit, Human/blood
- Decision Making
- Down Syndrome/diagnosis
- Down Syndrome/economics
- Down Syndrome/genetics
- Female
- France/epidemiology
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Insurance, Health, Reimbursement/economics
- Insurance, Health, Reimbursement/standards
- Maternal Age
- Pregnancy
- Pregnancy Outcome/economics
- Pregnancy Outcome/epidemiology
- Premature Birth/epidemiology
- Premature Birth/etiology
- Regression Analysis
- Risk Assessment
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Abstract
OBJECTIVE The objective of this study was to determine the cost-effectiveness of using transdermal nitroglycerin (GTN) for cases of preterm labor. METHODS The study included 153 women with clinical preterm labor, who were randomly allocated to either a GTN or placebo arm. All randomized cases were included in the final economic analysis. Differences between the two arms in gestational age at delivery, neonatal intensive care unit (NICU) admission, length of NICU stay, and NICU cost were assessed. Costs for non-NICU cases were calculated using Ottawa Hospital data through the Ontario Case Costing Initiative (OCCI). Cost-effectiveness and sensitivity analyses using a hospital perspective were both conducted. RESULTS In the 153 randomized cases, 55 babies were admitted to NICU (GTN = 24; placebo = 31). We found no significant differences between the two arms in gestational age at delivery, NICU admission rate (32.4% vs. 39.2%), NICU length of stay (42.7 days vs. 52.8 days), or NICU cost (CAN $34,306 vs. CAN $44,326). Overall, (based on all randomized cases) the cost-effectiveness analyses showed that the GTN arm was the dominant strategy, with both lower cost (CAN $13,397 vs. CAN $18,427) and higher NICU admission avoided rate (67.6% vs. 60.8%) compared to the placebo arm. This dominance persisted in all sensitivity analyses. CONCLUSION The use of GTN patch for preterm labor could reduce NICU costs, while improving important neonatal outcomes.
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Affiliation(s)
- Yanfang Guo
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada
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Ward TCS, Mori N, Patrick TB, Madsen MK, Cisler RA. Influence of socioeconomic factors and race on birth outcomes in urban Milwaukee. WMJ 2010; 109:254-260. [PMID: 21066930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE A national study found that infants born in low socioeconomic areas had the worst infant mortality rates (IMRs) and the highest racial disparity. Racial disparities in birth outcomes are also evident in the city of Milwaukee, with African American infants at 3 times greater the risk than white infants. This study was conducted to examine the influence of socioeconomic status (SES) and race on birth outcomes in the city of Milwaukee. METHODS Milwaukee ZIP codes were stratified into lower, middle, and upper SES groups. IMR, low birth weight, and preterm birth rates by race were analyzed by SES group for the years 2003 to 2007. RESULTS The overall IMR for the lower, middle, and upper SES groups were 12.4, 10.7, and 7.7, respectively. The largest racial disparity in IMR (3.1) was in the middle SES group, versus lower (1.6) and upper (1.8) SES groups. The overall percent of low birth weight infants for the lower, middle, and upper SES groups was 10.9%, 9.5%, and 7.5%, respectively. Racial disparity ratios in low birth weight were 2.0, 1.9, and 1.9 for lower, middle and upper SES groups. The overall percent of preterm birth was 15.4%, 13.2%, and 10.6% of births within the lower, middle, and upper SES groups, respectively, with a disparity ratio of 1.6 across all SES groups. CONCLUSIONS For all outcomes, African American infants born in the upper SES group fared the same or worse than white infants born in the lower SES group. Although higher SES appeared to have a protective effect for whites in Milwaukee, it did not have the same protective effect for African Americans.
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Affiliation(s)
- Trina C Salm Ward
- Center for Urban Population Health, 1020 N 12th St, Ste 4180, Milwaukee, WI 53233, USA.
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Parappil H, Rahman S, Salama H, Rifai HA, Parambil NK, Ansari WE. Outcomes of 28+1 to 32+0 weeks gestation babies in the state of Qatar: finding facility-based cost effective options for improving the survival of preterm neonates in low income countries. Int J Environ Res Public Health 2010; 7:2526-42. [PMID: 20644688 PMCID: PMC2905565 DOI: 10.3390/ijerph7062526] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 05/31/2010] [Accepted: 06/02/2010] [Indexed: 11/16/2022]
Abstract
In this retrospective study we did a comparative analysis of the outcome of 28(+1) to 32(+0) weeks gestation babies between the State of Qatar and some high income countries with an objective of providing an evidence base for improving the survival of preterm neonates in low income countries. Data covering a five year period (2002-2006) was ascertained on a pre-designed Performa. A comparative analysis with the most recent data from VON, NICHD, UK, France and Europe was undertaken. Qatar's 28(+1) to 32(+0) weeks Prematurity Rate (9.23 per 1,000 births) was less than the UK's (p < 0.0001). Of the 597 babies born at 28(+1) to 32(+0) weeks of gestation, 37.5% did not require any respiratory support, while 31.1% required only CPAP therapy. 80.12% of the MV and 96.28% of CPAP therapy was required for <96 hours. 86.1% of the mothers had received antenatal steroids. The 28(+1) to 32(+0) weeks mortality rate was 65.3/1,000 births with 30.77% deaths attributable to a range of lethal congenital and chromosomal anomalies. The survival rate increased with increasing gestational age (p < 0.001) and was comparable to some high income countries. The incidence of in hospital pre discharge morbidities in Qatar (CLD 2.68%, IVH Grade III 0.84%, IVH Grade IV 0.5%, Cystic PVL 0.5%) was less as compared to some high income countries except ROP >/= Stage 3 (5.69%), which was higher in Qatar. The incidence of symptomatic PDA, NEC and severe ROP decreased with increasing gestational age (p < 0.05). We conclude that the mortality and in hospital pre discharge morbidity outcome of 28(+1) to 32(+0) weeks babies in Qatar are comparable with some high income countries. In two thirds of this group of preterm babies, the immediate postnatal respiratory distress can be effectively managed by using two facility based cost effective interventions; antenatal steroids and postnatal CPAP. This finding is very supportive to the efforts of international perinatal health care planners in designing facility-based cost effective options for low income countries.
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Affiliation(s)
- Hussain Parappil
- NICU Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; E-Mails: (H.P.); (H.S.); (H.A.R.); (N.K.P.)
- Department of Paediatrics, Weill Cornell Medical College, Doha, Qatar
| | - Sajjad Rahman
- NICU Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; E-Mails: (H.P.); (H.S.); (H.A.R.); (N.K.P.)
- Department of Paediatrics, Weill Cornell Medical College, Doha, Qatar
| | - Husam Salama
- NICU Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; E-Mails: (H.P.); (H.S.); (H.A.R.); (N.K.P.)
- Department of Paediatrics, Weill Cornell Medical College, Doha, Qatar
| | - Hilal Al Rifai
- NICU Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; E-Mails: (H.P.); (H.S.); (H.A.R.); (N.K.P.)
- Department of Paediatrics, Weill Cornell Medical College, Doha, Qatar
| | - Najeeb Kesavath Parambil
- NICU Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; E-Mails: (H.P.); (H.S.); (H.A.R.); (N.K.P.)
- Department of Paediatrics, Weill Cornell Medical College, Doha, Qatar
| | - Walid El Ansari
- Faculty of Sport, Health and Social Care, University of Gloucestershire, Gloucester, UK; E-Mail:
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Baird J, Ma S, Ruger JP. Effects of the World Bank's maternal and child health intervention on Indonesia's poor: evaluating the safe motherhood project. Soc Sci Med 2010; 72:1948-55. [PMID: 20619946 DOI: 10.1016/j.socscimed.2010.04.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 04/20/2010] [Accepted: 04/27/2010] [Indexed: 11/18/2022]
Abstract
This article examines the impact of the World Bank's Safe Motherhood Project (SMP) on health outcomes for Indonesia's poor. Provincial data from 1990 to 2005 was analyzed combining a difference-in-differences approach in multivariate regression analysis with matching of intervention (SMP) and control group provinces and adjusting for possible confounders. Our results indicated that, after taking into account the impact of two other concurrent development projects, SMP was statistically significantly associated with a net beneficial change in under-five mortality, but not with infant mortality, total fertility rate, teenage pregnancy, unmet contraceptive need or percentage of deliveries overseen by trained health personnel. Unemployment and the pupil-teacher ratio were statistically significantly associated with infant mortality and percentage deliveries overseen by trained personnel, while pupil-teacher ratio and female education level were statistically significantly associated with under-five mortality. Clinically relevant changes (52-68% increase in the percentage of deliveries overseen by trained personnel, 25-33% decrease in infant mortality rate, and 8-14% decrease in under-five mortality rate) were found in both the intervention (SMP) and control groups.
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Affiliation(s)
- John Baird
- Yale University, 60 College Street, New Haven, CT 06520, United States
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Abstract
OBJECTIVES To examine the psychosocial risk (distress, stress, unintended pregnancy) and protective factors (social support, mastery, familism) associated with entry into prenatal care among low-income Hispanic women. METHODS Between April and September 2005, 483 postpartum Medicaid-eligible Hispanic women completed a survey at the hospital. RESULTS Only 69.5% of women initiated prenatal care in their first trimester. Protective factors were associated with earlier entry into prenatal care. Some risk factors were related to later entry, but relations became nonsignificant after considering protective factors. CONCLUSIONS Both protective and risk factors should be considered in evaluating the timing of prenatal care for low-income Hispanic women.
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Affiliation(s)
- Linda J Luecken
- Department of Psychology, Arizona State University, Tempe, AZ 85287-1104, USA.
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Hodges JS, Michalowicz BS. Re: Issues and early evidence for the economic evaluation of the effects of periodontal therapy on pregnancy outcomes. Quinonez R, Stearns SC. (J Periodontol 2008;79:203-206). J Periodontol 2008; 79:772; author reply 773. [PMID: 18454653 DOI: 10.1902/jop.2008.080113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sims M, Sims TH, Bruce MA. Community income, smoking, and birth weight disparities in Wisconsin. J Natl Black Nurses Assoc 2007; 18:16-23. [PMID: 18318327 PMCID: PMC5014333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study examined the extent to which community-level income and smoking status were associated with birth-weight disparities in the state of Wisconsin. Data included 1998 and 1999 birth record files with appended census income data for African-American, Latino, and White single births in Wisconsin. Multinomial logistic regression analysis was performed where the dependent variable included low birth weight (LBW: < 2,500 grams) and very low birth weight (VLBW: < 1,500 grams) relative to normal birth weight. The independent variables included income levels categorized as poor (< $12,499), lower middle ($12,500-34,999), and upper middle to affluent ($35,000 or more) determined by zip code, and smoking status (yes/no). African-American and Latino mothers who lived in poor communities and smoked were almost three times more likely to have a low birth weight (LBW) infant than their more affluent, non-smoking counterparts. Community income and smoking status played significant roles in birth weight disparities.
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Affiliation(s)
- Mario Sims
- Department of Medicine, Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS 39213, USA.
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Abstract
OBJECTIVE The purpose of this study was to compare 2 protocols for the antenatal management of isolated mild fetal pyelectasis and perform a cost analysis. METHODS A retrospective analysis of unilateral and bilateral mild fetal pyelectasis followed at our institution from 2003 to 2006 was conducted. Fetuses with additional congenital anomalies or aneuploidy were excluded. Chi(2) analysis was used, and P < .05 was considered significant. RESULTS Two hundred forty-four cases were identified, of which the majority were male (75.4% versus 24.6%). Eighty-eight patients were reevaluated every 4 weeks (protocol 1). The remaining 156 patients were reevaluated once in the third trimester (protocol 2). The mean number of ultrasound examinations in protocol 1 was 3.24, at a cost of $1187, compared with protocol 2, at $798. Resolution occurred in 59%, stabilization in 29%, and progression in 12%. There were no cases of progression to severe pyelectasis or a need for in utero intervention in either group. CONCLUSIONS Mild fetal pyelectasis can be managed with 1 additional third-trimester ultrasound examination without a compromise in patient care. Average cost savings were $389 per patient for protocol 2, suggesting a benefit from this protocol over protocol 1.
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Affiliation(s)
- Yasuko Yamamura
- Department of Obstetrics, Gynecology, and Women's Health, Division of Maternal-Fetal Medicine, University of Minnesota, 420 Delaware St, SE, MMC 395, Minneapolis, MN 55455, USA.
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Chambers GM, Chapman MG, Grayson N, Shanahan M, Sullivan EA. Babies born after ART treatment cost more than non-ART babies: a cost analysis of inpatient birth-admission costs of singleton and multiple gestation pregnancies. Hum Reprod 2007; 22:3108-15. [PMID: 17905747 DOI: 10.1093/humrep/dem311] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Currently, about one-third of infants born after assisted reproductive technology (ART) worldwide are twins or triplets. This study compared the inpatient birth-admission costs of singleton and multiple gestation ART deliveries to non-ART deliveries. METHODS A cohort of 5005 mothers and 5886 infants conceived following ART treatment were compared to 245 249 mothers and 248 539 infants in the general population. Birth-admission costs were calculated using Australian Refined Diagnosis Related Groups and weighted national average costs (2003-2004 euro). RESULTS ART infants were 4.4 times more likely to be low birthweight (LBW) compared with non-ART infants, translating into 89% higher birth-admission costs (euro2,832 and euro1,502, respectively). ART singletons were also more likely to be LBW compared with non-ART singletons, translating into 31% higher birth-admission costs (euro1,849 and euro1,415, respectively). After combining infant and maternal admission costs, the average cost of an ART singleton delivery was euro4,818 compared with euro13 890 for ART twins and euro54 294 for ART higher order multiples. Findings were not sensitive to changes in casemix. CONCLUSIONS The poorer neonatal outcomes of ART singletons compared with non-ART singletons are significant enough to impact healthcare resource consumption. The high costs associated with ART multiple births add to the overwhelming clinical and economic evidence in support of single embryo transfer.
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Affiliation(s)
- Georgina M Chambers
- National Perinatal Statistics Unit, School of Women's and Children's Health, University of New South Wales, Randwick Hospitals Campus, Randwick, NSW 2031, Australia.
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Hu D, Bertozzi SM, Gakidou E, Sweet S, Goldie SJ. The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico. PLoS One 2007; 2:e750. [PMID: 17710149 PMCID: PMC1939734 DOI: 10.1371/journal.pone.0000750] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 07/11/2007] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5--to reduce maternal mortality by three-quarters by 2015--will be met. METHODOLOGY/PRINCIPAL FINDINGS We developed an empirically calibrated model that simulates the natural history of pregnancy and pregnancy-related complications in a cohort of 15-year-old women followed over their lifetime. After synthesizing national and sub-national trends in maternal mortality, the model was calibrated to current intervention-specific coverage levels and validated by comparing model-projected life expectancy, total fertility rate, crude birth rate and maternal mortality ratio with Mexico-specific data. Using both published and primary data, we assessed the comparative health and economic outcomes of alternative strategies to reduce maternal morbidity and mortality. A dual approach that increased coverage of family planning by 15%, and assured access to safe abortion for all women desiring elective termination of pregnancy, reduced mortality by 43% and was cost saving compared to current practice. The most effective strategy added a third component, enhanced access to comprehensive emergency obstetric care for at least 90% of women requiring referral. At a national level, this strategy reduced mortality by 75%, cost less than current practice, and had an incremental cost-effectiveness ratio of $300 per DALY relative to the next best strategy. Analyses conducted at the state level yielded similar results. CONCLUSIONS/SIGNIFICANCE Increasing the provision of family planning and assuring access to safe abortion are feasible, complementary and cost-effective strategies that would provide the greatest benefit within a short-time frame. Incremental improvements in access to high-quality intrapartum and emergency obstetric care will further reduce maternal deaths and disability.
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Affiliation(s)
- Delphine Hu
- Program in Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | | | - Emmanuela Gakidou
- Harvard Initiative for Global Health, Cambridge, Massachusetts, United States of America
| | - Steve Sweet
- Program in Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Sue J. Goldie
- Program in Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Harvard Initiative for Global Health, Cambridge, Massachusetts, United States of America
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Abstract
Recently, several claims have been made that free provision of in vitro fertilisation (IVF) will boost our economy. This is premised on the assumption that people provide more in terms of tax and insurance than they consume in resources, leaving an overall gain. Even where these ‘replacement' people are created by means of IVF, it is argued that the costs involved are easily offset by the financial contribution we can expect IVF‐conceived adults to make to our economy. However, although it may be true that the creation of a new person constitutes an overall financial gain to the state, I question the degree to which the arithmetic involved is as simple as the reports suggest.
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Affiliation(s)
- Anna Smajdor
- Medical Ethics Unit, Imperial College, The Reynolds Building, St. Dunstan's Road, London W6 8RP.
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Boers KE, Bijlenga D, Mol BWJ, LeCessie S, Birnie E, van Pampus MG, Stigter RH, Bloemenkamp KWM, van Meir CA, van der Post JAM, Bekedam DJ, Ribbert LSM, Drogtrop AP, van der Salm PCM, Huisjes AJM, Willekes C, Roumen FJME, Scheepers HCJ, de Boer K, Duvekot JJ, Thornton JG, Scherjon SA. Disproportionate Intrauterine Growth Intervention Trial At Term: DIGITAT. BMC Pregnancy Childbirth 2007; 7:12. [PMID: 17623077 PMCID: PMC1933438 DOI: 10.1186/1471-2393-7-12] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 07/10/2007] [Indexed: 11/10/2022] Open
Abstract
Background Around 80% of intrauterine growth restricted (IUGR) infants are born at term. They have an increase in perinatal mortality and morbidity including behavioral problems, minor developmental delay and spastic cerebral palsy. Management is controversial, in particular the decision whether to induce labour or await spontaneous delivery with strict fetal and maternal surveillance. We propose a randomised trial to compare effectiveness, costs and maternal quality of life for induction of labour versus expectant management in women with a suspected IUGR fetus at term. Methods/design The proposed trial is a multi-centre randomised study in pregnant women who are suspected on clinical grounds of having an IUGR child at a gestational age between 36+0 and 41+0 weeks. After informed consent women will be randomly allocated to either induction of labour or expectant management with maternal and fetal monitoring. Randomisation will be web-based. The primary outcome measure will be a composite neonatal morbidity and mortality. Secondary outcomes will be severe maternal morbidity, maternal quality of life and costs. Moreover, we aim to assess neurodevelopmental and neurobehavioral outcome at two years as assessed by a postal enquiry (Child Behavioral Check List-CBCL and Ages and Stages Questionnaire-ASQ). Analysis will be by intention to treat. Quality of life analysis and a preference study will also be performed in the same study population. Health technology assessment with an economic analysis is part of this so called Digitat trial (Disproportionate Intrauterine Growth Intervention Trial At Term). The study aims to include 325 patients per arm. Discussion This trial will provide evidence for which strategy is superior in terms of neonatal and maternal morbidity and mortality, costs and maternal quality of life aspects. This will be the first randomised trial for IUGR at term. Trial registration Dutch Trial Register and ISRCTN-Register: ISRCTN10363217.
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Affiliation(s)
- Kim E Boers
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, The Netherlands
| | - Denise Bijlenga
- Department of Social Medicine, Academic Medical Center Amsterdam, The Netherlands
| | - Ben WJ Mol
- Department of Obstetrics and Gynaecology, Máxima Medical Center Veldhoven, The Netherlands
| | - Saskia LeCessie
- Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Tthe Netherlands
| | - Erwin Birnie
- Department of Public Health Economy, Erasmus Medical Center Rotterdam, The Netherlands
| | - Marielle G van Pampus
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, The Netherlands
| | - Rob H Stigter
- Department of Obstetrics and Gynaecology, Deventer Hospital, The Netherlands
| | - Kitty WM Bloemenkamp
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, The Netherlands
| | - Claudia A van Meir
- Department of Obstetrics and Gynaecology, Groene Hart Hospital Gouda, The Netherlands
| | - Joris AM van der Post
- Department of Obstetrics and Gynaecology, Academic Medical Center Amsterdam, The Netherlands
| | - Dick J Bekedam
- Department of Obstetrics and Gynaecology, OLVG Amsterdam, The Netherlands
| | - Lucy SM Ribbert
- Department of Obstetrics and Gynaecology, St. Antonius Hospital Nieuwegein, The Netherlands
| | - Addie P Drogtrop
- Department of Obstetrics and Gynaecology, TweeSteden Hospital Tilburg, The Netherlands
| | - Paulien CM van der Salm
- Department of Obstetrics and Gynaecology, Meander Medical Center Amersfoort, The Netherlands
| | - Anjoke JM Huisjes
- Department of Obstetrics and Gynaecology, Gelre Hospital Apeldoorn, The Netherlands
| | - Christine Willekes
- Department of Obstetrics and Gynaecology, University Hospital Maastricht, The Netherlands
| | - Frans JME Roumen
- Department of Obstetrics and Gynaecology, Atrium Medical Center Heerlen, The Netherlands
| | | | | | - Johannes J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus Medical Center Rotterdam, The Netherlands
| | - Jim G Thornton
- Department of Obstetrics and Gynaecology and Child Health, University of Nottingham, Nottingham City Hospital, UK
| | - Sicco A Scherjon
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, The Netherlands
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van der Ham DP, Nijhuis JG, Mol BWJ, van Beek JJ, Opmeer BC, Bijlenga D, Groenewout M, Arabin B, Bloemenkamp KWM, van Wijngaarden WJ, Wouters MGAJ, Pernet PJM, Porath MM, Molkenboer JFM, Derks JB, Kars MM, Scheepers HCJ, Weinans MJN, Woiski MD, Wildschut HIJ, Willekes C. Induction of labour versus expectant management in women with preterm prelabour rupture of membranes between 34 and 37 weeks (the PPROMEXIL-trial). BMC Pregnancy Childbirth 2007; 7:11. [PMID: 17617892 PMCID: PMC1934382 DOI: 10.1186/1471-2393-7-11] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 07/06/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preterm prelabour rupture of the membranes (PPROM) is an important clinical problem and a dilemma for the gynaecologist. On the one hand, awaiting spontaneous labour increases the probability of infectious disease for both mother and child, whereas on the other hand induction of labour leads to preterm birth with an increase in neonatal morbidity (e.g., respiratory distress syndrome (RDS)) and a possible rise in the number of instrumental deliveries. METHODS/DESIGN We aim to determine the effectiveness and cost-effectiveness of immediate delivery after PPROM in near term gestation compared to expectant management. Pregnant women with preterm prelabour rupture of the membranes at a gestational age from 34+0 weeks until 37+0 weeks will be included in a multicentre prospective randomised controlled trial. We will compare early delivery with expectant monitoring. The primary outcome of this study is neonatal sepsis. Secondary outcome measures are maternal morbidity (chorioamnionitis, puerperal sepsis) and neonatal disease, instrumental delivery rate, maternal quality of life, maternal preferences and costs. We anticipate that a reduction of neonatal infection from 7.5% to 2.5% after induction will outweigh an increase in RDS and additional costs due to admission of the child due to prematurity. Under these assumptions, we aim to randomly allocate 520 women to two groups of 260 women each. Analysis will be by intention to treat. Additionally a cost-effectiveness analysis will be performed to evaluate if the cost related to early delivery will outweigh those of expectant management. Long term outcomes will be evaluated using modelling. DISCUSSION This trial will provide evidence as to whether induction of labour after preterm prelabour rupture of membranes is an effective and cost-effective strategy to reduce the risk of neonatal sepsis. CONTROLLED CLINICAL TRIAL REGISTER: ISRCTN29313500.
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MESH Headings
- Cost-Benefit Analysis
- Female
- Fetal Membranes, Premature Rupture/economics
- Fetal Membranes, Premature Rupture/prevention & control
- Fetal Membranes, Premature Rupture/therapy
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Premature, Diseases/economics
- Infant, Premature, Diseases/prevention & control
- Labor, Induced/methods
- Pregnancy
- Pregnancy Outcome/economics
- Pregnancy Trimester, Third
- Prospective Studies
- Term Birth
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Affiliation(s)
- David P van der Ham
- Department of Obstetrics and Gynaecology, VieCuri Medical Centre Venlo, the Netherlands
| | - Jan G Nijhuis
- Department of Obstetrics and Gynaecology, University Hospital Maastricht, the Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Maxima Medical Centre Veldhoven, the Netherlands
| | - Johannes J van Beek
- Department of Obstetrics and Gynaecology, VieCuri Medical Centre Venlo, the Netherlands
| | - Brent C Opmeer
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre Amsterdam, the Netherlands
| | - Denise Bijlenga
- Department of Social Medicine, Academic Medical Centre Amsterdam, the Netherlands
| | - Mariette Groenewout
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, the Netherlands
| | - Birgit Arabin
- Department of Obstetrics and Gynaecology Isala Klinieken Zwolle, the Netherlands
| | - Kitty WM Bloemenkamp
- Department of Obstetrics and Gynaecology, University Medical Centre Leiden, the Netherlands
| | - Wim J van Wijngaarden
- Department of Obstetrics and Gynaecology, Bronovo Hospital the Hague, the Netherlands
| | - Maurice GAJ Wouters
- Department of Obstetrics and Gynaecology, VU Medical Centre Amsterdam, the Netherlands
| | - Paula JM Pernet
- Department of Obstetrics and Gynaecology, Kennemer Gasthuis Haarlem, the Netherlands
| | - Martina M Porath
- Department of Obstetrics and Gynaecology, Maxima Medical Centre Veldhoven, the Netherlands
| | - Jan FM Molkenboer
- Department of Obstetrics and Gynaecology, Sint Anna Hospital Geldrop, the Netherlands
| | - Jan B Derks
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, the Netherlands
| | - Michael M Kars
- Department of Obstetrics and Gynaecology, Mesos Medical Centre Utrecht, the Netherlands
| | - Hubertina CJ Scheepers
- Department of Obstetrics and Gynaecology, University Medical Centre Sint Radboud Nijmegen, the Netherlands
| | - Martin JN Weinans
- Department of Obstetrics and Gynaecology, Gelderse Vallei Hospital Ede, the Netherlands
| | - Mallory D Woiski
- Department of Obstetrics and Gynaecology, University Medical Centre Sint Radboud Nijmegen, the Netherlands
| | - Hajo IJ Wildschut
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre Rotterdam, the Netherlands
| | - Christine Willekes
- Department of Obstetrics and Gynaecology, University Hospital Maastricht, the Netherlands
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Declercq E, Barger M, Cabral HJ, Evans SR, Kotelchuck M, Simon C, Weiss J, Heffner LJ. Maternal Outcomes Associated With Planned Primary Cesarean Births Compared With Planned Vaginal Births. Obstet Gynecol 2007; 109:669-77. [PMID: 17329519 DOI: 10.1097/01.aog.0000255668.20639.40] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the outcomes and costs associated with primary cesarean births with no labor (planned cesareans) to vaginal and cesarean births with labor (planned vaginal). METHODS Analysis was based on a Massachusetts data system linking 470,857 birth certificates, fetal death records, and birth-related hospital discharge records from 1998 and 2003. We examined a subset of 244,088 mothers with no prior cesarean and no documented prenatal risk. We then divided mothers into two groups: those with no labor and a primary cesarean (planned primary cesarean deliveries-3,334 women) and those with labor and either a vaginal birth or a cesarean delivery (planned vaginal-240,754 women). We compared maternal rehospitalization rates and analyzed costs and length of stay. RESULTS Rehospitalizations in the first 30 days after giving birth were more likely in planned cesarean (19.2 in 1,000) when compared with planned vaginal births (7.5 in 1,000). After controlling for age, parity, and race or ethnicity, mothers with a planned primary cesarean were 2.3 (95% confidence interval [CI] 1.74-2.9) times more likely to require a rehospitalization in the first 30 days postpartum. The leading causes of rehospitalization after a planned cesarean were wound complications (6.6 in 1,000) (P<.001) and infection (3.3 in 1,000). The average initial hospital cost of a planned primary cesarean of US dollars 4,372 (95% C.I. US dollars 4,293-4,451) was 76% higher than the average for planned vaginal births of US dollars 2,487 (95% C.I. US dollars 2,481-2,493), and length of stay was 77% longer (4.3 days to 2.4 days). CONCLUSION Clinicians should be aware of the increased risk for maternal rehospitalization after cesarean deliveries to low-risk mothers when counseling women about their choices. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Eugene Declercq
- Department of Maternal and Child Health, Department of Biostatistics, Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
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Abstract
BACKGROUND The simultaneous rise over the last two decades in the U.S. in the proportion of VLBW (<1500 grams) deliveries and the improvement in their chance of survival has increased the number of families caring for VLBW infants and children. The families of VLBW infants with adverse outcomes can face psychological and monetary stresses, which in turn may influence marital instability and increase the risk of divorce or separation. The purpose of this paper is to identify the relationship of having a VLBW birth with the probability of divorce or separation in the first two years following delivery. METHODS We use data from the 1988 National Maternal and Infant Health Survey (NMIHS). This national stratified, systematic "follow-back" survey augments information from birth records in 1988 by obtaining information on social, demographic, and economic variables from women that delivered a baby in 1988. We estimate a proportional discrete time hazard model of transitions to divorce/separation. RESULTS Parents of a VLBW infant have 2-fold higher odds of divorce/separation compared with parents of a child with a birth weight greater than 1500 grams. Two years after delivery of a non-VLBW baby 95 percent of the marriages remain stable, while about 90 percent of the marriages remain stable following the birth of a VLBW baby. If the pregnancy was not desired, then only 85 percent of the marriages remain stable 2 years following the delivery of a VLBW infant. CONCLUSIONS There is an evident need to counsel and support families with VLBW infants on mechanisms to cope with the initial stressors that can be anticipated to arise.
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Affiliation(s)
- Shailender Swaminathan
- Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, 320-A Ryals Building, 1665 University Boulevard, Birmingham, Alabama 35294-0022, USA.
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Abstract
INTRODUCTION Despite the many contraceptive options available in the United States, nearly half (49%) of the 6.4 million pregnancies each year are unintended; these represent a significant cost to the health care system. METHODS The total number of unintended pregnancies and their outcomes were obtained from the literature. Direct medical costs were estimated for each unintended pregnancy outcome. RESULTS The direct medical costs of unintended pregnancies were US$5 billion in 2002. Direct medical cost savings due to contraceptive use were US$19 billion. DISCUSSION Unintended pregnancies are a costly problem in the United States. Contraceptive use can reduce direct and indirect costs; hence, payers may realize cost savings by providing coverage of contraceptive products.
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Affiliation(s)
- James Trussell
- Office of Population Research, Princeton University, Princeton, NJ 08544, USA.
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Brownell MD, Guevremont A, Au W, Sirski M. The Manitoba Healthy Baby Prenatal Benefit Program: who is participating? Can J Public Health 2007; 98:65-9. [PMID: 17278681 PMCID: PMC6975739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Programs offering income supplements for lower-income pregnant women have been introduced in order to reduce the incidence of poor perinatal outcomes. This study used a population-based approach to examine the characteristics of mothers who received the Healthy Baby Prenatal Benefit in Manitoba. METHODS All women giving birth between August 2001 and April 2003 (n = 22,643) were studied using de-identified linked administrative data. Multivariate logistic regression was used to determine factors that predicted receipt of the benefit, adjusting for potential confounding effects. Separate regressions were run for all mothers, and for a group of mothers eligible to receive the benefit (N = 1962). RESULTS Almost 29% of mothers giving birth during the study period received the prenatal benefit. Mothers were more likely to receive the benefit if they: lived outside of Winnipeg; received income assistance during pregnancy; were younger at their first birth; were unmarried; made prenatal physician visits; experienced maternal depression; were having a first birth; and lived in the lowest income areas. Despite all being eligible, only 67% of non-Winnipeg and 80% of Winnipeg women receiving income assistance received the benefit. Factors related to benefit receipt for those eligible were: living in Winnipeg; making prenatal visits; not being a young teen at current birth; and experiencing a first birth. CONCLUSION It is important to look not only at the characteristics of benefit recipients but also at those not receiving the benefit, in order to develop strategies to reach those who may most need and benefit from the program.
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Affiliation(s)
- Marni D Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg.
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