New York City Department of Health and Mental Hygiene, Long Island City, New York; and New York City Health+Hospitals/Kings County, Brooklyn, New York.
Obstet Gynecol. 2018 Feb;131(2):242-252. doi: 10.1097/AOG.0000000000002432.
To quantify the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries over a 5-year period in New York City adjusting for other sociodemographic and clinical factors.
We conducted a population-based cross-sectional study using linked birth certificates and hospital discharge data for New York City deliveries from 2008 to 2012. Severe maternal morbidity was defined using a published algorithm of International Classification of Diseases, 9 Revision, Clinical Modification disease and procedure codes. Hospital costs were estimated by converting hospital charges using factors specific to each year and hospital and to each diagnosis. These estimates approximate what it costs the hospital to provide services (excluding professional fees) and were used in all subsequent analyses. To estimate adjusted mean costs associated with severe maternal morbidity, we used multivariable regression models with a log link, gamma distribution, robust standard errors, and hospital fixed effects, controlling for age, race and ethnicity, neighborhood poverty, primary payer, number of deliveries, method of delivery, comorbidities, and year. We used the adjusted mean cost to determine the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries from 2008 to 2012.
Approximately 2.3% (n=13,502) of all New York City delivery hospitalizations were complicated by severe maternal morbidity. Compared with nonsevere maternal morbidity deliveries, these hospitalizations were clinically complicated, required more and intensive clinical services, and had a longer stay in the hospital. The average cost of delivery with severe maternal morbidity was $14,442 (95% CI $14,128-14,756), compared with $7,289 (95% CI $7,276-7,302) among deliveries without severe maternal morbidity. After adjusting for other factors, the difference between deliveries with and without severe maternal morbidity remained high ($6,126). Over 5 years, this difference resulted in approximately $83 million in total excess costs (13,502×$6,126).
Severe maternal morbidity nearly doubled the cost of delivery above and beyond other drivers of cost, resulting in tens of millions of excess dollars spent in the health care system in New York City. These findings can be used to demonstrate the burden of severe maternal morbidity and evaluate the cost-effectiveness of interventions to improve maternal health.
通过调整其他社会人口统计学和临床因素，量化纽约市 5 年内与重度产妇发病率超过非重度产妇发病率相关的平均和总住院分娩费用。
我们使用 2008 年至 2012 年纽约市分娩的链接出生证明和医院出院数据进行了一项基于人群的横断面研究。重度产妇发病率是使用国际疾病分类第 9 版临床修订版疾病和程序代码的已发表算法定义的。使用特定于每年、医院和每个诊断的因素转换医院收费来估计医院费用。这些估计值近似于医院提供服务的成本（不包括专业费用），并在所有后续分析中使用。为了估计与重度产妇发病率相关的调整后平均费用，我们使用具有对数链接、伽马分布、稳健标准误差和医院固定效应的多变量回归模型，控制年龄、种族和民族、社区贫困、主要支付者、分娩次数、分娩方式、合并症和年份。我们使用调整后的平均成本来确定 2008 年至 2012 年期间，与非重度产妇发病率相关的重度产妇发病率导致的平均和总住院分娩费用。
纽约市约有 2.3%（n=13502）的分娩住院治疗与重度产妇发病率有关。与非重度产妇发病率的分娩相比，这些住院治疗的临床表现更为复杂，需要更多和更密集的临床服务，住院时间也更长。患有重度产妇发病率的分娩的平均分娩费用为 14442 美元（95%置信区间 14128-14756），而没有重度产妇发病率的分娩的平均分娩费用为 7289 美元（95%置信区间 7276-7302）。在调整其他因素后，患有和不患有重度产妇发病率的分娩之间的差异仍然很高（6126 美元）。在 5 年内，这一差异导致纽约市医疗保健系统总超额费用约为 8300 万美元（13502×6126）。
重度产妇发病率使分娩成本增加了近一倍，超过了其他成本驱动因素，导致纽约市医疗保健系统额外花费了数千万美元。这些发现可用于证明重度产妇发病率的负担，并评估改善产妇健康的干预措施的成本效益。
