Am J Perinatol
DOI: 10.1055/s-0041-1740237
SMFM Fellows Research Series

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

1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2  Division of Maternal-Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
,
Torri D. Metz
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2  Division of Maternal-Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
,
Richard E. Nelson
3  Division of Epidemiology, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
4  Division of Pediatric Administration, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah
,
Sophie E. Janes
5  University of Utah School of Medicine, University of Utah Health, Salt Lake City, Utah
,
Alexandra Kroes
5  University of Utah School of Medicine, University of Utah Health, Salt Lake City, Utah
,
Lori J. Begaye
6  Department of International Studies, University of Utah, Salt Lake City, Utah
,
Cara C. Heuser
2  Division of Maternal-Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
,
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2  Division of Maternal-Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
,
Robert M. Silver
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
,
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2  Division of Maternal-Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
,
Brett D. Einerson
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2  Division of Maternal-Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
› Author Affiliations
Funding This research was funded by the Health Policy Scholarship Award from the Society for Maternal-Fetal Medicine and AMAG Pharmaceuticals. The funders did not have input or influence regarding the design or conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Additionally, data collection support via REDCap was provided in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR002538. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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.

Previous Publication

An earlier version of this work was accepted for presentation at the 2020 American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting in Seattle, WA, April 24–27, 2020. The meeting was canceled prior to presentation due to the global COVID-19 pandemic.


Supplementary Material



Publication History

Received: 05 June 2021

Accepted: 03 October 2021

Publication Date:
02 December 2021 (online)

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