Twenty-Week Abortion Bans on Pregnancies With a Congenital Diaphragmatic Hernia: A Cost-Effectiveness Analysis

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 131; no. 3; pp. 581 - 590
• Main Authors: Bullard, Kimberley A., Shaffer, Brian L., Greiner, Karen S., Skeith, Ashley E., Rodriguez, Maria I., Caughey, Aaron B.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01.03.2018; by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved
• Subjects: Abortion, Eugenic - economics; Abortion, Eugenic - legislation & jurisprudence; Cost-Benefit Analysis; Decision Trees; Female; Health Care Costs - statistics & numerical data; Health Policy - economics; Hernias, Diaphragmatic, Congenital - economics; Hernias, Diaphragmatic, Congenital - therapy; Humans; Infant, Newborn; Models, Economic; Monte Carlo Method; Pregnancy; Pregnancy Trimester, Second; Quality-Adjusted Life Years; United States; United States
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0000000000002483

OBJECTIVE:To estimate the effect of 20-week abortion bans on maternal and consequent neonatal health outcomes and costs in the setting of fetal congenital diaphragmatic hernia. METHODS:A decision-analytic model was built using TreeAge software to evaluate the effect of a 20-week ban on abortion in a theoretical cohort of 921 women diagnosed with fetal congenital diaphragmatic hernia. Probabilities, utilities, and costs were derived from the literature. The cohort size was based on the annual rate of prenatal diagnoses of congenital diaphragmatic hernia and live births among the 20 states with bans. The threshold for cost-effectiveness was set at $100,000 per quality-adjusted life-year. Analysis was completed from the maternal perspective. Clinical outcomes included mode of delivery, maternal death, intrauterine fetal death, neonatal death, neurodevelopmental disability, and use of extracorporeal membrane oxygenation. One-way sensitivity analysis was used on all variables and Monte Carlo simulation was performed. RESULTS:A policy restricting termination was associated with higher costs, at an additional $158,419,623, with decreased quality of life and 674 fewer quality-adjusted life-years. With 20-week bans in place, 60 women would travel out of state to obtain abortions. There would be 158 more live births affected by congenital diaphragmatic hernia. Of these births, 45 neonates would die before 28 days after birth and an additional 37 would have long-term neurodevelopmental disability. CONCLUSION:In this model, bans that limit abortions beyond 20 weeks of gestation were associated with worse health outcomes and increased costs for women with pregnancies complicated by congenital diaphragmatic hernia. The restriction of health care access should be considered in terms of the long-term outcomes and economic effect on individuals and society.