Costs of Severe Maternal Morbidity During Pregnancy in US Commercially Insured and Medicaid Populations: An Observational Study
To estimate the maternity-related cost of health care services in women with and without severe maternal morbidity (SMM).
Women with a live inpatient birth in the calendar year 2013 were identified in the MarketScan® Commercial and Medicaid health insurance claims databases. Costs were defined as the amounts paid by insurers plus out-of-pocket and third-party payments. Costs were calculated as total maternity-related costs and categorized as prenatal, delivery, and postpartum costs. SMM was identified using the CDC algorithm of 25 ICD-9 diagnostic and procedural codes. Variables associated with higher delivery costs were determined by multivariable linear regression analysis.
A total of 750 women met the criteria for SMM in the Commercial population. The total, per-patient mean costs of care for women without and with SMM were $14,840 and $20,380, respectively. Delivery hospitalization costs were 76-77% of total mean costs for women without and with SMM. A total of 99 women met the criteria for SMM in the Medicaid population. The total, per-patient mean costs of care for women without and with SMM were $6894 and $10,134, respectively. Delivery costs were 71–72% of total costs. Variables independently predictive of increased delivery costs in both Commercial and Medicaid populations were delivery by cesarean section, multifetal gestation, gestational hypertension/preeclampsia, and obstetric infection.
The occurrence of SMM was associated with an increase in maternity-related costs of 37% in the Commercial and 47% in the Medicaid population. Some of the factors associated with increased delivery hospitalization costs may be prevented.
KeywordsComorbidity Health care costs Hospitalization Insurance claim review Pregnancy complications United States
The authors thank Michelle Fox, MD, MPH, and Michelle Vichnin, MD, for their contributions to this project. Anna Kaufman, MPH and Melissa Stauffer, PhD, in collaboration with ScribCo, provided medical writing assistance.
Funding for this study was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.
Compliance with Ethical Standards
Conflict of interest
KKV reports no conflict of interest. At the time of the study, SF, YC, TR, CMB, and FAR were employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.
- Bruce, F. C., Berg, C. J., Joski, P. J., Roblin, D. W., Callaghan, W. M., Bulkley, J. E., et al. (2012). Extent of maternal morbidity in a managed care population in Georgia. Paediatric and Perinatal Epidemiology,26(6), 497–505. https://doi.org/10.1111/j.1365-3016.2012.01318.x.CrossRefPubMedPubMedCentralGoogle Scholar
- Centers for Disease Control and Prevention. (2017). Severe maternal morbidity in the United States. Retrieved November 27, 2017, from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html.
- Grobman, W. A., Bailit, J. L., Rice, M. M., Wapner, R. J., Reddy, U. M., Varner, M. W., et al. (2015). Racial and ethnic disparities in maternal morbidity and obstetric care. Obstetrics and Gynecology,125(6), 1460–1467. https://doi.org/10.1097/aog.0000000000000735.CrossRefPubMedPubMedCentralGoogle Scholar
- James, A. H., Patel, S. T., Watson, W., Zaidi, Q. R., Mangione, A., & Goss, T. F. (2008). An assessment of medical resource utilization and hospitalization cost associated with a diagnosis of anemia in women with obstetrical bleeding in the United States. Journal of Womens Health (Larchmt),17(8), 1279–1284. https://doi.org/10.1089/jwh.2007.0605.CrossRefGoogle Scholar
- Kuklina, E. V., Whiteman, M. K., Hillis, S. D., Jamieson, D. J., Meikle, S. F., Posner, S. F., et al. (2008). An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Maternal and Child Health Journal,12(4), 469–477. https://doi.org/10.1007/s10995-007-0256-6.CrossRefPubMedGoogle Scholar
- Law, A., McCoy, M., Lynen, R., Curkendall, S. M., Gatwood, J., Juneau, P. L., et al. (2015a). The additional cost burden of preexisting medical conditions during pregnancy and childbirth. Journal of Womens Health (Larchmt),24(11), 924–932. https://doi.org/10.1089/jwh.2014.4951.CrossRefGoogle Scholar
- Main, E. K., Abreo, A., McNulty, J., Gilbert, W., McNally, C., Poeltler, D., et al. Kilpatrick, S. (2016). Measuring severe maternal morbidity: validation of potential measures. American Journal of Obstetrics and Gynecology, 214(5), 643 e641–643 e610. https://doi.org/10.1016/j.ajog.2015.11.004 CrossRefGoogle Scholar
- Menacker, F., & Hamilton, B. E. (2010). Recent trends in cesarean delivery in the United States. NCHS Data Brief,35, 1–8.Google Scholar
- New York City Department of Health and Mental Hygiene. (2016). Severe Maternal Morbidity in New York City, 2008-2012. New York: New York City Department of Health and Mental Hygiene.Google Scholar
- Ozimek, J. A., Eddins, R. M., Greene, N., Karagyozyan, D., Pak, S., Wong, M., et al. Kilpatrick, S. J. (2016). Opportunities for improvement in care among women with severe maternal morbidity. American Journal of Obstetrics and Gynecology, 215(4), 509 e501–506. https://doi.org/10.1016/j.ajog.2016.05.022.CrossRefGoogle Scholar
- Podulka, J., Stranges, E., & Steiner, C. (2011). Hospitalizations Related to Childbirth, 2008: HCUP Statistical Brief #110. Retrieved from Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb110.pdf: https://www.ncbi.nlm.nih.gov/pubmed/21735572.
- Truven Health Analytics. (2013). The Cost of Having a Baby in the United States: Executive Summary. Google Scholar