Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
Am J Obstet Gynecol. 2023 Sep;229(3):331.e1-331.e9. doi: 10.1016/j.ajog.2023.06.029. Epub 2023 Jun 15.
Eviction during pregnancy has been shown to be associated with adverse birth outcomes. A safety net program focused on covering the costs of rent during pregnancy may aid in preventing adverse complications.
This study aimed to evaluate the cost-effectiveness of a program covering the cost of rent to prevent eviction during pregnancy.
A cost-effectiveness model using TreeAge software was designed to evaluate the cost, effectiveness, and incremental cost-effectiveness ratio associated with eviction compared to no eviction during pregnancy. The cost of eviction from a societal perspective was compared to the annual cost of housing in the no eviction group, which was estimated by the median contract rent in the United States from 2021 national census data. Birth outcomes included preterm birth, neonatal death, and major neurodevelopmental delay. Probabilities and costs were derived from the literature. The cost-effectiveness threshold was set at $100,000/QALY. We performed univariable and multivariable sensitivity analyses to assess the robustness of the results.
In our theoretical cohort of 30,000 pregnant individuals aged 15 to 44 years facing eviction annually, the no eviction during pregnancy strategy was associated with 1427 fewer preterm births, 47 fewer neonatal deaths, and 44 fewer cases of neurodevelopmental delay compared to eviction. At the median cost of rent in the United States, the no eviction strategy was associated with increased quality-adjusted life-years and decreased costs. Therefore, the no eviction strategy was the dominant strategy. In univariate sensitivity analysis varying the cost of housing, no eviction remained the cost-effective strategy and was cost-saving when rent was below $1016 per month.
The no eviction strategy is cost-effective and reduces cases of preterm birth, neonatal death, and neurodevelopmental delay. When rent is below the median of $1016 per month, no eviction is the cost-saving strategy. These findings suggest that policies supporting social programmatic implementation for rent coverage for pregnant people at risk of eviction have the potential to be highly beneficial in reducing costs and disparities in perinatal outcomes.
已有研究表明，孕期被驱逐与不良分娩结局有关。一项专注于支付孕期租金的安全网计划可能有助于预防不良并发症。
本研究旨在评估一项支付租金以防止孕期被驱逐的计划的成本效益。
采用 TreeAge 软件设计成本效益模型，以评估与孕期被驱逐相比，不被驱逐的成本、效果和增量成本效益比。从社会角度比较驱逐的成本与不驱逐组的年住房成本，这是通过 2021 年美国全国人口普查数据中的美国中位数合同租金来估计的。分娩结局包括早产、新生儿死亡和主要神经发育迟缓。概率和成本来自文献。成本效益阈值设定为 10 万美元/QALY。我们进行了单变量和多变量敏感性分析，以评估结果的稳健性。
在我们的理论队列中，每年有 30000 名年龄在 15 至 44 岁之间面临驱逐的孕妇，与驱逐相比，不驱逐孕期的策略与 1427 例早产减少、47 例新生儿死亡和 44 例神经发育迟缓减少相关。在美国租金中位数的情况下，不驱逐策略与增加的质量调整生命年和降低的成本相关。因此，不驱逐策略是主导策略。在住房成本的单变量敏感性分析中，不驱逐仍然是具有成本效益的策略，当租金低于每月 1016 美元时，不驱逐是节省成本的策略。
不驱逐策略具有成本效益，并减少了早产、新生儿死亡和神经发育迟缓的发生。当租金低于每月 1016 美元的中位数时，不驱逐是节省成本的策略。这些发现表明，支持为面临驱逐风险的孕妇提供租金覆盖的社会计划实施的政策，有可能在降低成本和减少围产期结局的差异方面具有高度益处。
