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Cost and Access Cost of Care

Societal cost of nine selected maternal morbidities in the United States

O'Neil SS, Platt I, Vohra D, Pendl-Robinson E, Dehus E, Zephyrin L, Zivin K

Published October 26, 2022 PLoS One
DOI 10.1371/journal.pone.0275656 PMID 36288323 PMC PMC9603953

RRM Academy Synopsis

Nine maternal conditions cost an estimated $32.3 billion, 2019 births

A cost model estimates that nine selected maternal morbidity conditions cost society $32.3 billion through five years after birth among all pregnancies and births across the United States in 2019. The total works out to $8,624 per birthing person. Maternal mental health conditions, hypertensive disorders and gestational diabetes produced the largest shares.

Study at a glance, cost model: Nine maternal conditions cost an estimated $32.3 billion
Study at a glance, cost model: Nine maternal conditions cost an estimated $32.3 billion. Source: O'Neil SS et al., 2022, PMID 36288323.

Key Findings

  • Across the nine conditions, the model produced a societal cost of $32.3 billion over the period from conception to five years after delivery, or $8,624 per birthing person.
  • Medical costs were $18.7 billion and nonmedical costs were $13.6 billion. Two-thirds of the costs fell in the first year postpartum.
  • Hemorrhage accounted for $1.8 billion, gestational diabetes mellitus $4.8 billion, hypertensive disorders $7.5 billion and maternal mental health conditions $18.1 billion.
  • The model attributed about 74% of the total costs ($24.0 billion) to child outcomes and about 26% ($8.3 billion) to maternal outcomes. Preterm birth accounted for $13.7 billion.
  • Sensitivity analyses that varied every prevalence and impact input together produced a total ranging from $12.1 billion to $57.6 billion.

Interpretation

This cost model drew on published research from 2010 to 2021, tracking nine maternal health conditions from conception through five years after birth. Maternal mental health conditions cost the most, followed by high blood pressure disorders and gestational diabetes. The authors note that the total leaves out hospital readmissions and costs after five years, so it likely understates the real cost. The findings support more research into the long-term costs of these conditions and ways to prevent them.

RRM Context

Restorative reproductive medicine looks for the root cause of a health problem. It follows reproductive health across a person's life, including the years before pregnancy. The paper's cost count begins at conception. Hypertensive disorders and gestational diabetes, the second and third costliest conditions in the model, involve blood pressure and blood sugar. A whole-person evaluation takes both into account.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To estimate the cost of maternal morbidity for all 2019 pregnancies and births in the United States.

Methods

Using data from 2010 to 2020, we developed a cost analysis model that calculated the excess cases of outcomes attributed to nine maternal morbidity conditions with evidence of outcomes in the literature. We then modeled the associated medical and nonmedical costs of each outcome incurred by birthing people and their children in 2019, projected through five years postpartum.

Results

We estimated that the total cost of nine maternal morbidity conditions for all pregnancies and births in 2019 was $32.3 billion from conception to five years postpartum, amounting to $8,624 in societal costs per birthing person.

Conclusion

We found only nine maternal morbidity conditions with sufficient supporting evidence of linkages to outcomes and costs. The lack of comprehensive data for other conditions suggests that maternal morbidity exacts a higher toll on society than we found.

Policy Implications

Although this study likely provides lower bound cost estimates, it establishes the substantial adverse societal impact of maternal morbidity and suggests further opportunities to invest in maternal health.

Topics

Related research

Cost and Access › Cost of Care › Treatment Costs · Birth and Delivery › Birth Outcomes › Maternal Morbidity
Sasigant So O'Neil, Isabel Platt, Divya Vohra, Emma Pendl-Robinson, Eric Dehus, Laurie Zephyrin, Kara Zivin
S O'Neil, I Platt, D Vohra, E Pendl-Robinson, E Dehus, L Zephyrin, K Zivin
PMID 36288323 36288323 DOI 10.1371/journal.pone.0275656 10.1371/journal.pone.0275656 O'Neil et al. 2022, O'Neil 2022

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