title: Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil.
abstract: OBJECTIVE
  Pregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications. Hospital costs increase according to the type of care provided. This study aimed to estimate the cost-benefit relationship and social profitability ratio of hospitalization, compared with outpatient care, for pregnant women with diabetes or mild hyperglycemia.
  
  
  METHODS
  This was a prospective observational quantitative study conducted at a university hospital. It included all pregnant women with pregestational or gestational diabetes, or mild hyperglycemia, who did not develop clinical intercurrences during pregnancy and who delivered at the Botucatu Medical School Hospital (Hospital das Clínicas, Faculdade de Medicina de Botucatu, HC-FMB) of Universidade Estadual de São Paulo (Unesp).
  
  
  METHODS
  Thirty pregnant women treated with diet were followed as outpatients, and twenty treated with diet plus insulin were managed through frequent short hospitalizations. Direct costs (personnel, materials and tests) and indirect costs (general expenses) were ascertained from data in the patients' records and the hospital's absorption costing system. The cost-benefit was then calculated.
  
  
  RESULTS
  Successful treatment of pregnant women with diabetes avoided expenditure of US$ 1,517.97 and US$ 1,127.43 for patients treated with inpatient and outpatient care, respectively. The cost-benefit of inpatient care was US$ 143,719.16, and outpatient care, US$ 253,267.22, with social profitability of 1.87 and 5.35, respectively.
  
  
  CONCLUSIONS
  Decision-tree analysis confirmed that successful treatment avoided costs at the hospital. Cost-benefit analysis showed that outpatient management was economically more advantageous than hospitalization. The social profitability of both treatments was greater than one, thus demonstrating that both types of care for diabetic pregnant women had positive benefits.
authors.affiliation: Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil. acmolinacavassini@hotmail.com
authors.forename: Ana Claudia Molina
authors.initials: AC
authors.lastname: Cavassini
authors.forename: Silvana Andréa Molina
authors.initials: SA
authors.lastname: Lima
authors.forename: Iracema Mattos Paranhos
authors.initials: IM
authors.lastname: Calderon
authors.forename: Marilza Vieira Cunha
authors.initials: MV
authors.lastname: Rudge
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics*; D001938:Brazil; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D016640:Diabetes, Gestational / Q000191:economics* / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D006943:Hyperglycemia / Q000191:economics* / Q000628:therapy; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics*; D011446:Prospective Studies; D012959:Socioeconomic Factors