RESEARCH OBJECTIVE: Preeclampsia (new-onset high blood pressure occurring in pregnancy after 20 weeks gestation with signs of problems with the kidneys, liver, and other organs) is a leading cause of prematurity, maternal and neonatal morbidity and mortality. Incidence of preeclampsia has risen due in part to more frequent pregnancies of women with obesity or higher maternal age. Evidence of the economic burden of preeclampsia is scarce primarily due to considerable data-related challenges, e.g. identifying preeclampsia cases accurately and matching mothers and infants, and no study has estimated the cost burden of preeclampsia among mothers and infants using primary data. The objective of this study is to provide the first observational, case-based preeclampsia healthcare cost estimates for mothers and infants from a payer perspective, with comparisons to normal and hypertensive pregnancies.
STUDY DESIGN: Electronic health record and billing data from a large regional integrated healthcare system in Pennsylvania, Geisinger, were used to identify mother-infant pairs and compile data on their clinical care and costs using actual payment amounts. Three pregnancy study cohorts (preeclampsia, normal and hypertension) were defined and matched using a 1:1:1 ratio on the basis of mother’s age, parity, BMI and comorbidities. Time period studied was from 20 weeks gestation to 6 weeks post-delivery for mothers and from birth to 12 months for infants. Costs per pregnancy were calculated in 2015 dollars for both mothers and infants, and the incremental costs of preeclampsia were estimated by subtracting the average cost of the matched cohorts. Differences in cohort characteristics were compared, including early delivery, cesarean section and adverse events.
POPULATION STUDIED: A total of 2,154 mother and singleton infant pairs with deliveries between October 2010 and December 2015 at two large hospitals in Geisinger.
PRINCIPAL FINDINGS: Preliminary results were based on 718 matched mother/infant pairs in preeclampsia, hypertension and normal pregnancy cohorts. Incremental costs of a preeclampsia case were $30,641 ($3,694 for mothers and $26,947 for infants) compared to normal and $20,277 ($1,336 and $18,941) to hypertension. The mean cost per infant was dependent on gestational age, ranging from $183,883 at less than 28 weeks to $5,587 at full term. Mothers with preeclampsia had earlier deliveries with 37.1 median gestational weeks at birth compared to 39.1 for hypertension and 39.6 for normal (p<0.0001). Mothers with preeclampsia had more cesarean sections at 52.5% compared to 31.6% for normal pregnancy cohort and 36.7% for hypertension cohort (p<0.0001). A significantly larger percentage of preeclampsia mothers and infants (13.9% for mothers and 15.5% for infants) experienced adverse events compared to normal (3.5% and 0.7%) and hypertension (9.1% and 5.3%) (p<0.0001).
CONCLUSIONS: The economic burden of preeclampsia healthcare costs is significant with the main cost drivers being infant healthcare costs associated with lower gestational age and greater adverse outcomes.
