Department of Pharmacoeconomics and Pharmacoepidemiology, University of Groningen, Groningen, the Netherlands.
Department of Pharmacoeconomics and Pharmacoepidemiology, University of Groningen, Groningen, the Netherlands ; Global Market Access Solutions, Saint-Prex, Switzerland.
Int J Womens Health. 2014 Jul 16;6:663-70. doi: 10.2147/IJWH.S61543. eCollection 2014.
Unintended pregnancy (UP) is an unmet medical need with consequences worldwide. We evaluate the costs of UP based on pregnancies in Brazil from for the year 2010.
The consequences of UP were evaluated using decision analysis based on pregnancy rates and outcomes as miscarriage, induced abortion, and live birth, which were factored into the analysis. The model discriminated between maternal and child outcomes and accounted for costs (in Brazilian currency [Real$, R$]) within the Brazilian public health service attributed to preterm birth, neonatal admission, cerebral palsy, and neonatal and maternal mortality. Event probabilities were obtained from local resources.
We estimate that 1.8 million UPs resulted in 159,151 miscarriages, 48,769 induced abortions, 1.58 million live births, and 312 maternal deaths, including ten (3%) attributed to unsafe abortions. The total estimated costs attributed to UP are R$4.1 billion annually, including R$32 million (0.8%) and R$4.07 billion (99.2%) attributed to miscarriages and births and complications, respectively. Direct birth costs accounted for approximately R$1.22 billion (30.0%), with labor and delivery responsible for most costs (R$988 million; 24.3%) for the year 2010. The remainder of costs were for infant complications (R$2.84 billion; 72.3%) with hospital readmission during the first year accounting for approximately R$2.15 billion (52.9%). Based on the national cost, we estimate the cost per UP to be R$2,293.
Despite weaknesses in precise estimates in annual pregnancies and induced abortions, our estimates reflect the costs of UP for different pregnancy outcomes. The main costs associated with UP are in those carried to parturition. The health cost of abortion represents a small proportion of total costs as these are paid for outside of the public health system. Consequently, reductions in UP will generate not only cost savings, but reductions in woman and child morbidity and mortality.
非意愿妊娠（UP）是一种未满足的医疗需求，在全球范围内造成了各种后果。我们评估了 2010 年巴西妊娠相关 UP 的成本。
基于妊娠率和妊娠结局（如流产、人工流产和活产），采用决策分析评估 UP 的后果。该模型区分了母婴结局，并考虑了早产、新生儿入院、脑瘫以及新生儿和产妇死亡等归因于 UP 的巴西公共卫生服务成本（巴西雷亚尔[Real$，R$]）。事件概率来自当地资源。
我们估计有 180 万例 UP 导致 159151 例流产、48769 例人工流产、158 万例活产和 312 例产妇死亡，其中 10 例（3%）归因于不安全流产。每年归因于 UP 的总估计成本为 41 亿雷亚尔，其中流产和活产及并发症分别占 3200 万雷亚尔（0.8%）和 40.7 亿雷亚尔（99.2%）。直接分娩费用约为 12.2 亿雷亚尔（30.0%），其中分娩费用占大部分（9.88 亿雷亚尔；24.3%）。其余费用用于婴儿并发症（28.4 亿雷亚尔；72.3%），其中第一年的医院再次入院费用约为 21.5 亿雷亚尔（52.9%）。基于国家成本，我们估计每例 UP 的成本为 2293 雷亚尔。
尽管每年妊娠和人工流产的精确估计存在一定局限性，但我们的估计反映了不同妊娠结局的 UP 成本。与 UP 相关的主要成本与分娩相关。由于这些费用是在公共卫生系统之外支付的，因此堕胎的健康费用仅占总费用的一小部分。因此，减少 UP 不仅可以节省成本，还可以降低母婴发病率和死亡率。
