Exploring the intangible economic costs of stillbirth.
BACKGROUND
Compared to other pregnancy-related events, the full cost of stillbirth remains poorly described. In the UK one in every 200 births ends in stillbirth. As a follow-up to a recent study which explored the direct costs of stillbirth, this study aimed to explore the intangible costs of stillbirth in terms of their duration and economic implication.


METHODS
Systematic searches identified relevant papers on the psychological consequences of stillbirth. A narrative review of the quantitative studies was undertaken. This was followed by a qualitative synthesis using meta-ethnography to identify over-arching themes common to the papers. Finally, the themes were used to generate questions proposed for use in a questionnaire to capture the intangible costs of stillbirth.


RESULTS
The narrative review revealed a higher level of anxiety and depression in couples with stillbirth compared to those without stillbirth. The qualitative synthesis identified a range of psychological effects common to families that have experienced stillbirth. Both methods revealed the persistent nature of these effects and the subsequent economic burden.


CONCLUSIONS
The psychological effects of stillbirth adversely impacts on the daily functioning, relationships and employment of those affected with far-reaching economic implications. Knowledge of the intangible costs of stillbirth is therefore important to accurately estimate the size of the impact on families and health services and to inform policy and decision making.
Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. cbo321@bham.ac.uk.
Chidubem B
CB
Ogwulu
Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. l.jackson.1@bham.ac.uk.
Louise J
LJ
Jackson
Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and Manchester Academic Health Science Centre, St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK. alexander.heazell@manchester.ac.uk.
Alexander E P
AE
Heazell
Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. t.e.roberts@bham.ac.uk.
Tracy E
TE
Roberts
D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000503:physiopathology; D003362:Cost-Benefit Analysis; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007398:Interpersonal Relations; D033262:Narration; D020380:Needs Assessment; D011181:Postnatal Care / Q000191:economics; D011247:Pregnancy; D018570:Risk Assessment; D012934:Social Isolation; D050497:Stillbirth / Q000191:economics* / Q000523:psychology*; D006113:United Kingdom