Directly Measured Costs of Severe Maternal Morbidity Events during Delivery Admission Compared with Uncomplicated Deliveries

Michelle P. Debbink; Torri D. Metz; Richard E. Nelson; Sophie E. Janes; Alexandra Kroes; Lori J. Begaye; Cara C. Heuser; Marcela C. Smid; Robert M. Silver; Michael W. Varner; Brett D. Einerson

doi:10.1055/s-0041-1740237

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2022; 39(06): 567-576
DOI: 10.1055/s-0041-1740237

SMFM Fellowship Series Article

Directly Measured Costs of Severe Maternal Morbidity Events during Delivery Admission Compared with Uncomplicated Deliveries

Michelle P. Debbink

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Division of Maternal-Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah

,

Torri D. Metz

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Division of Maternal-Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah

,

Richard E. Nelson

³Division of Epidemiology, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah

⁴Division of Pediatric Administration, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah

,

Sophie E. Janes

⁵University of Utah School of Medicine, University of Utah Health, Salt Lake City, Utah

,

Alexandra Kroes

⁵University of Utah School of Medicine, University of Utah Health, Salt Lake City, Utah

,

Lori J. Begaye

⁶Department of International Studies, University of Utah, Salt Lake City, Utah

,

Cara C. Heuser

²Division of Maternal-Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah

,

Marcela C. Smid

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Division of Maternal-Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah

,

Robert M. Silver

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

,

Michael W. Varner

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Division of Maternal-Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah

,

Brett D. Einerson

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Division of Maternal-Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah

› Institutsangaben

Abstract

Objective To estimate the actual excess costs of care for delivery admissions complicated by severe maternal morbidity (SMM) compared with uncomplicated deliveries.

Study Design This is a retrospective cohort study of all deliveries between October 2015 and September 2018 at a single tertiary academic center. Pregnant individuals ≥ 20 weeks' gestation who delivered during a hospital admission (i.e., a “delivery admission”) were included. The primary exposure was SMM, as defined by Centers for Disease Control and Prevention (CDC) criteria, CDC criteria excluding blood transfusion, or by validated hospital-defined criteria (intensive care unit admission or ≥ 4 units of blood products). Potential SMM events identified via administrative and blood bank data were reviewed to confirm SMM events had occurred. Primary outcome was total actual costs of delivery admission derived from time-based accounting and acquisition costs in the institutional Value Driven Outcomes database. Cost of delivery admissions with SMM events was compared with the cost of uncomplicated delivery using adjusted generalized linear models, with separate models for each of the SMM definitions. Relative cost differences are reported due to data restrictions.

Results Of 12,367 eligible individuals, 12,361 had complete cost data. Two hundred and eighty individuals (2.3%) had confirmed SMM events meeting CDC criteria. CDC criteria excluding transfusion alone occurred in 1.0% (n = 121) and hospital-defined SMM in 0.6% (n = 76). In adjusted models, SMM events by CDC criteria were associated with a relative cost increase of 2.45 times (95% confidence interval [CI]: 2.29–2.61) the cost of an uncomplicated delivery. SMM by CDC criteria excluding transfusion alone was associated with a relative increase of 3.26 (95% CI: 2.95–3.60) and hospital-defined SMM with a 4.19-fold (95% CI: 3.64–4.83) increase. Each additional CDC subcategory of SMM diagnoses conferred a relative cost increase of 1.60 (95% CI: 1.43–1.79).

Conclusion SMM is associated with between 2.5- and 4-fold higher cost than uncomplicated deliveries.

Key Points

Severe maternal morbidity as defined by CDC criteria confers a 2.5-fold increase in delivery hospitalization costs.
Intensive care unit admission or ≥ 4 units of blood products confer a fourfold increase in cost.
Costs of maternal morbidity may motivate SMM review.

Keywords

severe maternal morbidity - cost - value

Volltext

Referenzen

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