432: A cost analysis of chronic hypertension in a California cohort of pregnant women

Abstract

Hospital costs in the United States are variable, with data lacking on the association between hospital costs and maternal and neonatal outcomes. Our objective was to estimate maternal and neonatal hospital costs among women with chronic hypertension in pregnancy in a large cohort of pregnant women. We conducted a retrospective cohort study of women with singleton, non-anomalous births in California from 2007 to 2011. We included only women with gestational ages greater than 23 weeks. Hospital costs were estimated separately for women and neonates using hospital charges adjusted using a cost-to-charge ratio of 0.58. This cost included hospital cost for admission for delivery only. We estimated the differences in median cost (maternal and neonatal) between chronic hypertension compared with no chronic hypertension. We also estimated length of stay for women and neonates, and estimated the gestational age at delivery. Analyses were conducted utilizing Kruskal-Wallis equality-of-populations rank tests with a significance cutoff of 0.05. In a California cohort of 2,401,049 women, 29,748 (1.2%) had chronic hypertension. The median hospital cost was $3,467 higher among women with chronic hypertension when compared to women without chronic hypertension (Table 1, p< 0.001). Length-of-stays were significantly different for women and neonates, in addition to gestational age at delivery (Table 1, p< 0.001). Median hospital costs were significantly higher for women with chronic hypertension regardless of mode of delivery or gestational age at delivery (Table 2a, p< 0.001). While the hospital costs for maternal Intensive Care Unit (ICU) admission did not significantly differ, the hospital cost was significantly higher among women with severe maternal morbidity and neonatal ICU admission (Table 2b, p< 0.001). In this analysis, the cost of chronic hypertension was significantly greater as compared to no chronic hypertension in pregnancy. This analysis allows for a greater understanding of the hospital costs associated with chronic hypertension in pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)