Policies Restricting Medicaid Coverage for Pregnancy Termination in Women With Moderate Chronic Kidney Disease [8F

Abstract

INTRODUCTION: Recent policies have attempted to restrict which reproductive health services Medicaid can cover. Under these policies, a woman seeking an abortion with renal disease requiring dialysis treatment, but not a woman with moderate (Stage 3) chronic kidney disease (CKD) can undergo a termination covered by Medicaid. Our objective was to analyze the costs and outcomes associated with a policy that does not cover a pregnancy termination in a woman with moderate CKD. METHODS: A decision-analytic model was constructed using TreeAge 2016 software, and all probabilities were derived from the literature. We calculated our costs and outcomes using a hypothetical cohort of 5,000 women with CKD who experience an unintended pregnancy and would be covered by Medicaid. Primary outcomes included the cost associated with this policy restriction and the cost per quality adjusted life year (QALY). A cost-effectiveness threshold was set at $100,000 per QALY. RESULTS: In our cohort of 5,000 women, restricting funding for abortion in cases of Stage 3 CKD results in an additional societal cost of $5 million. Our cohort also experienced a decrease of 20 QALYs, 3 more cases of progression to Stage 4 CKD and 1 to dialysis, the same number of neonatal deaths, 6 more cases of intrauterine growth restriction, 11 more preterm deliveries and 7 more instances of preeclampsia. CONCLUSION: Restricting Medicaid coverage for abortion results in an increased economic burden and worse maternal and neonatal outcomes. These policy bans should consider both the health care and economic impact to women when deciding to enact these policies.