OBJECTIVES: Preeclampsia in pregnancy is a leading cause of prematurity, and maternal and neonatal morbidity and mortality. Incidence has risen in part from trends in obesity and older age in pregnant women. Evidence of preeclampsia costs is scarce due to data challenges identifying preeclampsia cases and matching mothers and infants. This is the first study using primary data to provide U.S. case-based preeclampsia healthcare cost estimates for mothers and infants from a payer perspective, with comparisons to both normal and hypertensive pregnancies.
METHODS: Electronic health record and billing data from a large regional integrated healthcare system in Pennsylvania, Geisinger, were used to identify mother-singleton infant pairs with deliveries between October 2010 and December 2015. Data on their clinical care and costs using actual payment amounts were compiled for the following time periods: 20 weeks gestation to 6 weeks post-delivery for mothers and birth to 12 months for infants. 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. Costs per pregnancy were calculated in 2015 dollars and preeclampsia incremental costs estimated by subtracting the average cost of the matched cohorts.
RESULTS: Preliminary results for 2,154 matched mother-infant pairs, 718 in each cohort, are preeclampsia case incremental costs of $30,641 ($3,694 for mothers and $26,947 for infants) compared to normal and $20,277 ($1,336 and $18,941) compared to hypertension. Mean cost per infant was dependent on gestational age, ranging from $183,883 at <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).
CONCLUSIONS: Preeclampsia healthcare costs for mothers and infants are significant with the main cost driver being infant healthcare costs associated with lower gestational age.
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