Abstract
BackgroundThe aim of this study was to estimate the cost of childbirth in a teaching hospital in Barcelona, Spain, including the costs of prenatal care, delivery and postnatal care (3 months). Costs were assessed by taking into account maternal origin and delivery type.MethodsWe performed a cross-sectional study of all deliveries in a teaching hospital to mothers living in its catchment area between October 2006 and September 2007. A process cost analysis based on a full cost accounting system was performed. The main information sources were the primary care program for sexual and reproductive health, and hospital care and costs records. Partial and total costs were compared according to maternal origin and delivery type. A regression model was fit to explain the total cost of the childbirth process as a function of maternal age and origin, prenatal care, delivery type, maternal and neonatal severity, and multiple delivery.ResultsThe average cost of childbirth was 4,328€, with an average of 18.28 contacts between the mother or the newborn and the healthcare facilities. The delivery itself accounted for more than 75% of the overall cost: maternal admission accounted for 57% and neonatal admission for 20%. Prenatal care represented 18% of the overall cost and 75% of overall acts. The average overall cost was 5,815€ for cesarean sections, 4,064€ for vaginal instrumented deliveries and 3,682€ for vaginal non-instrumented deliveries (p < 0.001). The regression model explained 45.5% of the cost variability. The incremental cost of a delivery through cesarean section was 955€ (an increase of 31.9%) compared with an increase of 193€ (6.4%) for an instrumented vaginal delivery. The incremental cost of admitting the newborn to hospital ranged from 420€ (14.0%) to 1,951€ (65.2%) depending on the newborn's severity. Age, origin and prenatal care were not statistically significant or economically relevant.ConclusionsNeither immigration nor prenatal care were associated with a substantial difference in costs. The most important predictors of cost were delivery type and neonatal severity. Given the impact of cesarean sections on the overall cost of childbirth, attempts should be made to take into account its higher cost in the decision of performing a cesarean section.
Highlights
The aim of this study was to estimate the cost of childbirth in a teaching hospital in Barcelona, Spain, including the costs of prenatal care, delivery and postnatal care (3 months)
The aim of this study was to evaluate the overall cost of the childbirth process including the costs of prenatal care, delivery and postnatal care up to 3 months after delivery, taking into account delivery type and maternal origin
More than 27% of deliveries were through cesarean section in both groups
Summary
The aim of this study was to estimate the cost of childbirth in a teaching hospital in Barcelona, Spain, including the costs of prenatal care, delivery and postnatal care (3 months). Variation in childbirth cost is principally determined by delivery type, which influences personnel and surgical requirements [9], as well as pre- and postnatal care, especially the postnatal hospital length of stay, both for the newborn and the mother [10,11]. An increase in cesarean sections in low-risk women from 1996 to 2003 was observed according to age, race and ethnicity, the major risk factor was previous cesarean section [12]. In countries such as the United States, women with a high socioeconomic position have greater access to prenatal care and a higher probability of delivery through cesarean section [13]. The debate is made more intense by the concurrence of increases in medically induced birth and decreased infant and fetal mortality rates [15,16]
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