Systematic Literature Review of the Costs of Pregnancy in the US
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SYSTEMATIC REVIEW
Systematic Literature Review of the Costs of Pregnancy in the US Lynn Huynh • Mark McCoy • Amy Law • Kevin N. Tran • Senta Knuth • Patrick Lefebvre Sean Sullivan • Mei Sheng Duh
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Published online: 25 October 2013 Springer International Publishing Switzerland 2013
Abstract Background The cost of pregnancy is increasing over time despite the decline in pregnancy rates. Objective To fully elucidate and evaluate the cost drivers of pregnancy in the US for payers, a systematic review was conducted to understand the main cost components and primary factors that contribute to the direct costs of pregnancy, pregnancy-related complications and unintended pregnancy among women of childbearing age (15–44 years). Data Sources We performed electronic searches in the PubMed database from January 2000 to December 2012, and major women’s health and pharmacoeconomics conference proceedings from 2011 to 2012. Study Selection The systematic review is comprised of studies that reported pregnancy, pregnancy-related complications, unplanned pregnancy, and pregnancy-induced monetary costs. The review excluded narrative reports, systematic reviews, model-derived cost of pregnancy
Electronic supplementary material The online version of this article (doi:10.1007/s40273-013-0096-8) contains supplementary material, which is available to authorized users. L. Huynh K. N. Tran S. Knuth M. S. Duh (&) Analysis Group, Inc., 111 Huntington Avenue, Tenth Floor, Boston, MA 02199, USA e-mail: [email protected] M. McCoy A. Law Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ, USA P. Lefebvre Groupe d’analyse, Lte´e, Montreal, QC, Canada S. Sullivan Veritech Corporation, Mercer Island, WA, USA
papers, non-US-based studies, and reports based solely on expert opinions. Study Appraisal and Synthesis Methods Two reviewers independently applied the inclusion criteria and assessed the quality of the data collected. Disagreements between reviewers were resolved by consensus or by arbitration through a third party, with reference to the original sources. We collected information on the study design and outcomes for each included study. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines in designing, performing, and reporting of the systematic review. Results We identified 40 studies from electronic and handsearching methods. We classified studies based on the primary research topic focusing on the overall cost of pregnancy (N = 10), cost of pregnancy-related complications (N = 26), cost of unintended pregnancy (N = 2), cost of planned pregnancy (N = 1), or cost of pregnancy by facilities (N = 1). In the quality assessment, randomized, non-randomized, and retrospective database studies had low to moderate risk of bias. We determined primary cost drivers based on the highest cost reported in each study. The identified cost drivers were inpatient care, pregnancy delivery, multiple births, complicated cesarean sections, high-risk pregnancy, preterm birth, low birth weight, complic
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