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Care-as-usual provided to formerly preeclamptic women in the Netherlands in the next pregnancy: health care consumption, costs and maternal and child outcome.

Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:240-5. doi: 10.1016/j.ejogrb.2014.04.033. Epub 2014 May 5.

Delahaije DH1, Smits LJ2, van Kuijk SM3, Peeters LL4, Duvekot JJ5, Ganzevoort W6, Oudijk MA4, van Pampus MG7, Scheepers HC8, Spaanderman ME8, Dirksen CD9.
Author information 1Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Obstetrics and Gynecology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: denise.delahaije@mumc.nl.2Department of Epidemiology, CAPHRI, Maastricht University, Maastricht, The Netherlands.3Department of Obstetrics and Gynecology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Epidemiology, CAPHRI, Maastricht University, Maastricht, The Netherlands.4Department of Obstetrics and Gynecology, University Medical Center Utrecht, The Netherlands.5Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands.6Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.7Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.8Department of Obstetrics and Gynecology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands.9Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands.
Eur J Obstet Gynecol Reprod Biol
ABSTRACT
AbstractOBJECTIVE: To explore hospital costs by pregnant women with a history of early-onset preeclampsia or HELLP syndrome, managed according to customary, but non-standardized prenatal care, by relating maternal and child outcome to maternal health care expenditure.STUDY DESIGN: This was a cohort study, in women of 18 years or older who suffered from early-onset preeclampsia or HELLP syndrome in their previous pregnancy (n=104). We retrieved data retrospectively from hospital information systems and medical records of patients who had received customary, non-standardized prenatal care between 1996 and 2012. Our analyses focused on the costs generated between the first antenatal visit at the outpatient clinic and postpartum hospital discharge. Outcome measures were hospital resource use, costs, maternal and child outcome (recurrence of preeclampsia or HELLP syndrome, incidence of eclampsia, gestational age at delivery, intrauterine fetal demise, small-for-gestational-age birth and low 5min Apgar score). We used linear regression analyses to evaluate whether maternal and child outcome and baseline characteristics correlated with hospital costs.RESULTS: Maternal hospital costs per patient averaged € 8047. The main cost drivers were maternal admissions and outpatient visits, together accounting for 80% of total costs. Primary cost drivers were preterm birth and recurrent preeclampsia or HELLP syndrome.CONCLUSION: Hospital costs in the next pregnancy of formerly preeclamptic women varied widely with over 70% being medically unexplainable. The results of this study support the view that care standardization in these women can be expected to improve costs and efficacy of care without compromising outcome.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Full Text Source: Elsevier Science
PMID:24835859 | http://www.ncbi.nlm.nih.gov/pubmed/24835859

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