In the JournalsPerspective

Preeclampsia results in significant health, cost burdens

Preeclampsia increases the chance of adverse health outcomes for mothers and their infants compared to mothers without preeclampsia and accounted for $2.18 billion in total medical expenditures within the first year after delivery in the United States in 2012, according to a report published in the American Journal of Obstetrics and Gynecology.

“From an epidemiological perspective, preeclampsia is growing at a rate more rapidly than diabetes, heart disease, Alzheimer’s disease, obesity and chronic kidney disease — diseases for which substantial research and treatment funding have been allocated,” senior author Anupam B. Jena, MD, PhD, Ruth L. Newhouse associate professor from the Department of Health Care Policy at Harvard Medical School and Massachusetts General Hospital, said in a press release. “Existing treatment options for preeclampsia and research into the disease have been limited despite the scale of the disease burden and its high growth rate.”

Since 1980, preeclampsia cases have risen from 2.4% of pregnancies to 3.8% in 2010. Although preeclampsia is a leading cause of maternal death and perinatal morbidity and mortality, no one had previously measured the overall health and cost burden of preeclampsia by gestational age among mothers and infants in the United States within the first year after delivery. Therefore, researchers analyzed the annual cost of preeclampsia in the United States using population-based and administrative data sets, including the National Center for Health Statistics Vital Statistics on Births, the California Perinatal Quality Care Collaborative Databases, the U.S. Health Care Cost and Utilization Project database and a commercial claims data set.

In total, the overall cost burden of preeclampsia during the first year after birth was $1.03 billion for expenses related to mothers and $1.15 billion for the care of infants, a combined amount which represented one-third of the total cost of obstetric care for these patients in the United States. Preeclampsia increased the chance of adverse health events from 4.6% to 10.1% for mothers and from 7.8% to 15.4% for infants, and also lowered gestational age by 1.7 weeks (P < 0.001). Depending on gestational age, the cost burden per infant ranged from $150,000 at 26 weeks to $1,311 at 36 weeks. For mothers, the most common preeclampsia-related adverse events were hemorrhage (3.1% to 5.4%) and thrombocytopenia (0.9% to 3.7%); while infants were at most increased risk for respiratory distress syndrome (1.9% to 6.6%) and sepsis (3% to 5.4%). Analysis showed preeclampsia affects more than just short-term health care costs; it also increases the risk for early onset cardiovascular diseases among women years after delivery.

“Further studies can improve upon this research by using cost data that are directly observable (rather than imputing costs),” Jena and colleagues wrote in the American Journal of Obstetrics and Gynecology. “Furthermore, extending the time window beyond the first 12 months after birth will provide a better understanding of how preeclampsia has an impact on women and children in the long term.”

In a related editorial, William M. Callaghan, MD, chief of the maternal and infant health branch at the CDC, and colleagues wrote that the findings of this report reveal the magnitude of how preeclampsia affects health care cost and health outcomes on a population level.

“Although preeclampsia has affected pregnant women for millennia, there is still much we do not know,” Callaghan wrote. “This new research underscores the urgent need to continue research into its causes and to implement strategies that may help women manage this condition.” – by Savannah Demko

Disclosures: This study was supported by rEVO Biologics, Inc. Callaghan reports no relevant financial disclosures. Jena is a consultant at Precision Health Economics. Please see the full study for a complete list of all other authors’ relevant financial disclosures.

Preeclampsia increases the chance of adverse health outcomes for mothers and their infants compared to mothers without preeclampsia and accounted for $2.18 billion in total medical expenditures within the first year after delivery in the United States in 2012, according to a report published in the American Journal of Obstetrics and Gynecology.

“From an epidemiological perspective, preeclampsia is growing at a rate more rapidly than diabetes, heart disease, Alzheimer’s disease, obesity and chronic kidney disease — diseases for which substantial research and treatment funding have been allocated,” senior author Anupam B. Jena, MD, PhD, Ruth L. Newhouse associate professor from the Department of Health Care Policy at Harvard Medical School and Massachusetts General Hospital, said in a press release. “Existing treatment options for preeclampsia and research into the disease have been limited despite the scale of the disease burden and its high growth rate.”

Since 1980, preeclampsia cases have risen from 2.4% of pregnancies to 3.8% in 2010. Although preeclampsia is a leading cause of maternal death and perinatal morbidity and mortality, no one had previously measured the overall health and cost burden of preeclampsia by gestational age among mothers and infants in the United States within the first year after delivery. Therefore, researchers analyzed the annual cost of preeclampsia in the United States using population-based and administrative data sets, including the National Center for Health Statistics Vital Statistics on Births, the California Perinatal Quality Care Collaborative Databases, the U.S. Health Care Cost and Utilization Project database and a commercial claims data set.

In total, the overall cost burden of preeclampsia during the first year after birth was $1.03 billion for expenses related to mothers and $1.15 billion for the care of infants, a combined amount which represented one-third of the total cost of obstetric care for these patients in the United States. Preeclampsia increased the chance of adverse health events from 4.6% to 10.1% for mothers and from 7.8% to 15.4% for infants, and also lowered gestational age by 1.7 weeks (P < 0.001). Depending on gestational age, the cost burden per infant ranged from $150,000 at 26 weeks to $1,311 at 36 weeks. For mothers, the most common preeclampsia-related adverse events were hemorrhage (3.1% to 5.4%) and thrombocytopenia (0.9% to 3.7%); while infants were at most increased risk for respiratory distress syndrome (1.9% to 6.6%) and sepsis (3% to 5.4%). Analysis showed preeclampsia affects more than just short-term health care costs; it also increases the risk for early onset cardiovascular diseases among women years after delivery.

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“Further studies can improve upon this research by using cost data that are directly observable (rather than imputing costs),” Jena and colleagues wrote in the American Journal of Obstetrics and Gynecology. “Furthermore, extending the time window beyond the first 12 months after birth will provide a better understanding of how preeclampsia has an impact on women and children in the long term.”

In a related editorial, William M. Callaghan, MD, chief of the maternal and infant health branch at the CDC, and colleagues wrote that the findings of this report reveal the magnitude of how preeclampsia affects health care cost and health outcomes on a population level.

“Although preeclampsia has affected pregnant women for millennia, there is still much we do not know,” Callaghan wrote. “This new research underscores the urgent need to continue research into its causes and to implement strategies that may help women manage this condition.” – by Savannah Demko

Disclosures: This study was supported by rEVO Biologics, Inc. Callaghan reports no relevant financial disclosures. Jena is a consultant at Precision Health Economics. Please see the full study for a complete list of all other authors’ relevant financial disclosures.

    Perspective

    The incidence of preeclampsia in the United States is increasing. Despite efforts to reduce adverse outcomes, preeclampsia remains a leading cause of maternal and perinatal morbidity and mortality. Preeclampsia is also associated with increased health care costs due to more intensive antepartum, postpartum and neonatal care, particularly due to higher rates of preterm birth. Literature evaluating the economic burden of preeclampsia by gestational age for women and infants is limited.

    In a recent issue of the American Journal of Obstetrics & Gynecology, Stevens and colleagues evaluated the economic costs of preeclampsia in the United States. This retrospective cohort study used administrative datasets to estimate the cost of preeclampsia for women and infants for up to one year after birth. The burden of preeclampsia to the health system in 2012 was found to be $2.18 billion ($1.03 billion for mothers and $1.15 billion for infants). Not surprisingly, the costs of care were gestational age-dependent, ranging from $150,000 at 26 weeks to $1,311 at 36 weeks.

    The authors point out that the rate of preeclampsia is rising faster than many other diseases to which greater research funding has been allocated. Despite the impact of preeclampsia on the lives of women and children, an understanding of the pathophysiology and interventions to prevent its complications remains elusive. Thus, the health and economic burdens conferred by preeclampsia will continue to grow. Research to identify methods to prevent and treat preeclampsia is critical to reducing its impact on the health of women and children.

    • Jeffrey D. Sperling MD, MS, and Dana R. Gossett, MD, MSCI
    • Department of Obstetrics, Gynecology, and Reproductive Sciences University of California, San Francisco

    Disclosures: Sperling and Gossett report no relevant financial disclosures.