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


METHODS
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.


CONCLUSIONS
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.
Department 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.
Denise H J
DH
Delahaije
Department of Epidemiology, CAPHRI, Maastricht University, Maastricht, The Netherlands.
Luc J M
LJ
Smits
Department of Obstetrics and Gynecology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Epidemiology, CAPHRI, Maastricht University, Maastricht, The Netherlands.
Sander M J
SM
van Kuijk
Department of Obstetrics and Gynecology, University Medical Center Utrecht, The Netherlands.
Louis L
LL
Peeters
Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands.
Johannes J
JJ
Duvekot
Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
Wessel
W
Ganzevoort
Department of Obstetrics and Gynecology, University Medical Center Utrecht, The Netherlands.
Martijn A
MA
Oudijk
Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Mariëlle G
MG
van Pampus
Department of Obstetrics and Gynecology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands.
Hubertina C J
HC
Scheepers
Department of Obstetrics and Gynecology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands.
Marc E
ME
Spaanderman
Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands.
Carmen D
CD
Dirksen
D000328:Adult; D001034:Apgar Score; D001724:Birth Weight; D005260:Female; D017359:HELLP Syndrome / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000191:economics*; D009426:Netherlands; D011225:Pre-Eclampsia / Q000191:economics*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000191:economics*; D012189:Retrospective Studies; D059039:Standard of Care / Q000191:economics*; D014930:Women
HELLP syndrome; Hospital costs; Preeclampsia; Resource use; Usual care