Elixhauser A, Weschler J M, Kitzmiller J L, Marks J S, Bennert H W, Coustan D R, Gabbe S G, Herman W H, Kaufmann R C, Ogata E S
Agency for Health Care Policy and Research, Department of Health and Human Services, Rockville, Maryland 20852.
Diabetes Care. 1993 Aug;16(8):1146-57. doi: 10.2337/diacare.16.8.1146.
To determine whether the additional costs of preconception care are balanced by the savings from averted complications. Several studies have demonstrated the efficacy of preconception care in reducing congenital anomalies in infants born of mothers with pre-existing diabetes mellitus.
This study used literature review, consensus development among an expert panel of physicians, and surveys of medical care personnel to obtain information about the costs and consequences of preconception plus prenatal care compared with prenatal care only for women with established diabetes. Preconception care involves close interaction between the patient and an interdisciplinary health-care team as well as intensified evaluation, follow-up, testing, and monitoring. The outcome measures assessed in this study are the medical costs of preconception care versus prenatal care only and the benefit-cost ratio.
The costs of preconception plus prenatal care are $17,519/delivery, whereas the costs of prenatal care only are $13,843/delivery. Taking into account maternal and neonatal adverse outcomes, the net savings of preconception care are $1720/enrollee over prenatal care only and the benefit-cost ratio is 1.86. The preconception care program remained cost saving across a wide range of assumptions regarding incidence of adverse outcomes and program cost components.
Despite significantly higher per delivery costs for participants in a hypothetical preconception care program, intensive medical care before conception resulted in cost savings compared with prenatal care only. Third-party payers can expect to realize cost savings by reimbursing preconception care in this high-risk population.
确定孕前保健的额外费用是否能被避免并发症所节省的费用所平衡。多项研究已证明孕前保健在降低患有糖尿病的母亲所生婴儿先天性异常方面的有效性。
本研究采用文献综述、医师专家小组达成共识以及对医护人员进行调查，以获取有关孕前加产前保健与仅针对确诊糖尿病女性的产前保健相比的成本和后果的信息。孕前保健涉及患者与跨学科医疗团队之间的密切互动以及强化评估、随访、检测和监测。本研究评估的结果指标是孕前保健与仅产前保健的医疗成本以及效益成本比。
孕前加产前保健的成本为每例分娩17,519美元，而仅产前保健的成本为每例分娩13,843美元。考虑到孕产妇和新生儿不良结局，与仅进行产前保健相比，孕前保健的净节省为每名登记参与者1720美元，效益成本比为1.86。在关于不良结局发生率和项目成本构成的广泛假设范围内，孕前保健项目仍能节省成本。
尽管假设的孕前保健项目参与者的每例分娩成本显著更高，但与仅进行产前保健相比，孕前强化医疗保健可节省成本。第三方支付者有望通过为这一高风险人群报销孕前保健费用来实现成本节省。
