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Systematic Literature Review of the Costs of Pregnancy in the US

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Abstract

Background

The cost of pregnancy is increasing over time despite the decline in pregnancy rates.

Objective

To fully elucidate and evaluate the cost drivers of pregnancy in the US for payers, a systematic review was conducted to understand the main cost components and primary factors that contribute to the direct costs of pregnancy, pregnancy-related complications and unintended pregnancy among women of childbearing age (15–44 years).

Data Sources

We performed electronic searches in the PubMed database from January 2000 to December 2012, and major women’s health and pharmacoeconomics conference proceedings from 2011 to 2012.

Study Selection

The systematic review is comprised of studies that reported pregnancy, pregnancy-related complications, unplanned pregnancy, and pregnancy-induced monetary costs. The review excluded narrative reports, systematic reviews, model-derived cost of pregnancy papers, non-US-based studies, and reports based solely on expert opinions.

Study Appraisal and Synthesis Methods

Two reviewers independently applied the inclusion criteria and assessed the quality of the data collected. Disagreements between reviewers were resolved by consensus or by arbitration through a third party, with reference to the original sources. We collected information on the study design and outcomes for each included study. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines in designing, performing, and reporting of the systematic review.

Results

We identified 40 studies from electronic and handsearching methods. We classified studies based on the primary research topic focusing on the overall cost of pregnancy (N = 10), cost of pregnancy-related complications (N = 26), cost of unintended pregnancy (N = 2), cost of planned pregnancy (N = 1), or cost of pregnancy by facilities (N = 1). In the quality assessment, randomized, non-randomized, and retrospective database studies had low to moderate risk of bias. We determined primary cost drivers based on the highest cost reported in each study. The identified cost drivers were inpatient care, pregnancy delivery, multiple births, complicated cesarean sections, high-risk pregnancy, preterm birth, low birth weight, complications due to conditions such as hypertension, diabetes, anemia, and cancer, and in vitro fertilization. In 2008, the overall mean cost per hospital stay for pregnancy-related incidence ranged from $3,306 to $9,234 in 2012 dollars. The mean cost of pregnancy-related complications that led to preterm birth was as high as $326,953 for an infant born at 25 weeks. It is estimated that over 50 % of live births were unintended in the US. The difference in the cost of unintended pregnancy and intended pregnancy was approximately $536 million.

Limitations

One limitation of the systematic review was the exclusion of model-based cost studies which were excluded because of the high level of variation and heterogeneity across sources of reported cost. Another limitation of the review is that the cost of pregnancy perspective is restricted to the US.

Conclusion

Preventing pregnancy-related complications and reducing unintended pregnancies may lower the overall economic burden of pregnancy on the US health care system.

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Conflicts of interest disclosure

Lynn Huynh, Kevin N. Tran, Senta Knuth, Patrick Lefebvre, and Mei Sheng Duh are employees of Analysis Group, Inc., a consulting company that has received research grants from Bayer HealthCare Pharmaceuticals, Inc. Mark McCoy and Amy Law are employees of Bayer HealthCare Pharmaceuticals, Inc. Sean Sullivan has received research funding from Bayer HealthCare Pharmaceuticals, Inc.

Author contributions

Lynn Huynh, Kevin N. Tran, and Senta Knuth contributed to the acquisition, analysis and interpretation of the data, manuscript development, and approval of the final submitted version. Patrick Lefebvre, Mei Sheng Duh, Mark McCoy, Amy Law, and Sean Sullivan conceived and planned the work that led to the manuscript, provided substantive suggestions for revisions, and approved the final submitted version.

Financial support

Financial support for this study was provided by Bayer HealthCare Pharmaceuticals, Inc.

Author information

Authors and Affiliations

  1. Analysis Group, Inc., 111 Huntington Avenue, Tenth Floor, Boston, MA, 02199, USA

    Lynn Huynh, Kevin N. Tran, Senta Knuth & Mei Sheng Duh

  2. Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ, USA

    Mark McCoy & Amy Law

  3. Groupe d’analyse, Ltée, Montreal, QC, Canada

    Patrick Lefebvre

  4. Veritech Corporation, Mercer Island, WA, USA

    Sean Sullivan

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  1. Lynn Huynh
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Correspondence to Mei Sheng Duh.

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Huynh, L., McCoy, M., Law, A. et al. Systematic Literature Review of the Costs of Pregnancy in the US. PharmacoEconomics 31, 1005–1030 (2013). https://doi.org/10.1007/s40273-013-0096-8

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