Cost-benefit analysis of preconception care for women with established diabetes mellitus.
OBJECTIVE
To determine whether the additional costs of preconception care are balanced by the savings from averted complications. Several studies have demonstrated the efficacy of preconception care in reducing congenital anomalies in infants born of mothers with pre-existing diabetes mellitus.


METHODS
This study used literature review, consensus development among an expert panel of physicians, and surveys of medical care personnel to obtain information about the costs and consequences of preconception plus prenatal care compared with prenatal care only for women with established diabetes. Preconception care involves close interaction between the patient and an interdisciplinary health-care team as well as intensified evaluation, follow-up, testing, and monitoring. The outcome measures assessed in this study are the medical costs of preconception care versus prenatal care only and the benefit-cost ratio.


RESULTS
The costs of preconception plus prenatal care are $17,519/delivery, whereas the costs of prenatal care only are $13,843/delivery. Taking into account maternal and neonatal adverse outcomes, the net savings of preconception care are $1720/enrollee over prenatal care only and the benefit-cost ratio is 1.86. The preconception care program remained cost saving across a wide range of assumptions regarding incidence of adverse outcomes and program cost components.


CONCLUSIONS
Despite significantly higher per delivery costs for participants in a hypothetical preconception care program, intensive medical care before conception resulted in cost savings compared with prenatal care only. Third-party payers can expect to realize cost savings by reimbursing preconception care in this high-risk population.
Agency for Health Care Policy and Research, Department of Health and Human Services, Rockville, Maryland 20852.
A
A
Elixhauser
J M
JM
Weschler
J L
JL
Kitzmiller
J S
JS
Marks
H W
HW
Bennert
D R
DR
Coustan
S G
SG
Gabbe
W H
WH
Herman
R C
RC
Kaufmann
E S
ES
Ogata
D001786:Blood Glucose / Q000032:analysis; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000191:economics* / Q000628:therapy*; D003927:Diet, Diabetic; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000191:economics / Q000453:epidemiology; D007349:Insurance, Health, Reimbursement / Q000191:economics; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011254:Pregnancy in Diabetics / Q000097:blood / Q000191:economics* / Q000628:therapy*; D011295:Prenatal Care / Q000191:economics*; D016896:Treatment Outcome; D014481:United States
D001786:Blood Glucose