Costs of Severe Maternal Morbidity During Pregnancy in US Commercially Insured and Medicaid Populations: An Observational Study

• Published in: Maternal and child health journal 2020, Vol.24 (1), p.30-38
• Main Authors: Vesco, Kimberly K., Ferrante, Shannon, Chen, Yong, Rhodes, Thomas, Black, Christopher M., Allen-Ramey, Felicia
• Format: Article
• Language: English
• Subjects: Adult; Childbirth; Cost of Illness; Female; Finance; Government programs; Gynecology; Health Care Costs - statistics & numerical data; Health care expenditures; Health Services - economics; Health Services - statistics & numerical data; Hospital maternity services; Hospitalization - economics; Hospitalization - statistics & numerical data; Humans; Hypertension; Insurance Claim Review - statistics & numerical data; Managed Care Programs - statistics & numerical data; Maternal & child health; Maternal and Child Health; Medicaid; Medicaid - economics; Medicine; Medicine & Public Health; Morbidity; Observational studies; Outcome Assessment, Health Care; Pediatrics; Population Economics; Pregnancy; Pregnancy complications; Pregnancy Complications - economics; Public Health; Regression analysis; Retrospective Studies; Sociology; Statistics; United States; Womens health
• ISSN: 1092-7875; 1573-6628
• DOI: 10.1007/s10995-019-02819-z

Objective To estimate the maternity-related cost of health care services in women with and without severe maternal morbidity (SMM). Methods Women with a live inpatient birth in the calendar year 2013 were identified in the MarketScan ® Commercial and Medicaid health insurance claims databases. Costs were defined as the amounts paid by insurers plus out-of-pocket and third-party payments. Costs were calculated as total maternity-related costs and categorized as prenatal, delivery, and postpartum costs. SMM was identified using the CDC algorithm of 25 ICD-9 diagnostic and procedural codes. Variables associated with higher delivery costs were determined by multivariable linear regression analysis. Results A total of 750 women met the criteria for SMM in the Commercial population. The total, per-patient mean costs of care for women without and with SMM were $14,840 and $20,380, respectively. Delivery hospitalization costs were 76-77% of total mean costs for women without and with SMM. A total of 99 women met the criteria for SMM in the Medicaid population. The total, per-patient mean costs of care for women without and with SMM were $6894 and $10,134, respectively. Delivery costs were 71–72% of total costs. Variables independently predictive of increased delivery costs in both Commercial and Medicaid populations were delivery by cesarean section, multifetal gestation, gestational hypertension/preeclampsia, and obstetric infection. Conclusions The occurrence of SMM was associated with an increase in maternity-related costs of 37% in the Commercial and 47% in the Medicaid population. Some of the factors associated with increased delivery hospitalization costs may be prevented.