A structured review and exploration of the healthcare costs associated with stillbirth and a subsequent pregnancy in England and Wales

Hema Mistry,Oluwaseyi Vincent,Alexander E P Heazell,Tracy Roberts

doi:10.1186/1471-2393-13-236

Abstract

BackgroundIn contrast to other pregnancy complications the economic impact of stillbirth is poorly understood. We aimed to carry out a preliminary exploration of the healthcare costs of stillbirth from the time of pregnancy loss and the period afterwards; also to explore and include the impact of a previous stillbirth on the healthcare costs of the next pregnancy.MethodsA structured review of the literature including cost studies and description of costs to health-care providers for care provided at the time of stillbirth and in a subsequent pregnancy. Costs in a subsequent pregnancy were compared in three alternative models of care for multiparous women developed from national guidelines and expert opinion: i) “low risk” women who had a live birth, ii) “high risk” women who had a live birth and iii) women with a previous stillbirth.ResultsThe costs to the National Health Service (NHS) for investigation immediately following stillbirth ranged from £1,242 (core recommended investigations) to £1,804 (comprehensive investigation). The costs in the next pregnancy following a stillbirth ranged from £2,147 (low-risk woman with a previous healthy child) to £3,751 (Woman with a previous stillbirth of unknown cause). The cost in the next pregnancy following a stillbirth due to a known recurrent or an unknown cause is almost £500 greater than the pregnancy following a stillbirth due to a known non-recurrent cause.ConclusionsThe study has highlighted the paucity of evidence regarding economic issues surrounding stillbirth. Women who have experienced a previous stillbirth are likely to utilise more health care services in their next pregnancy particularly where no cause is found. Every effort should be made to determine the cause of stillbirth to reduce the overall cost to the NHS. The cost associated with identifying the cause of stillbirth could offset the costs of care in the next pregnancy. Future research should concentrate on robust studies looking into the wider economic impact of stillbirth.

Highlights

In contrast to other pregnancy complications the economic impact of stillbirth is poorly understood
For comparison we developed care pathways for two other cohorts of pregnant multiparous women with singleton pregnancies, i) healthy women who had an uncomplicated first pregnancy ending in a live-birth and ii) women with designated “high-risk pregnancies” due to pre-existing conditions, for example, diabetes or hypertension whose first pregnancy ended in a live birth
We have attempted here to quantify the healthcare costs associated with stillbirth in three time periods, i) those which occur at the time of initial management of the stillbirth, ii) those which are incurred after the initial management has been completed and iii) those which occur in a subsequent pregnancy

Summary

Introduction

In contrast to other pregnancy complications the economic impact of stillbirth is poorly understood. In contrast to other pregnancy complications such as preterm birth and preeclampsia [4,5,6], the economic impact of stillbirth is poorly understood. This is problematic for two reasons; first it underestimates the societal impact of stillbirth in comparison to other pregnancy complications. It represents a major obstacle in the evaluation of strategies to reduce stillbirth, as investigators cannot compare the cost of an intervention against the reduction in costs associated with stillbirth. Several reports have discussed issues related to health economics of stillbirth [7,8,9]

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