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Estimating the Hospital Delivery Costs Associated With Severe Maternal Morbidity in New York City, 2008–2012

Howland, Renata, E., MPH; Angley, Meghan, MPH; Won, Sang, Hee, MPH; Wilcox, Wendy, MD, MPH; Searing, Hannah, MA-MHS; Tsao, Tsu-Yu, PhD

doi: 10.1097/AOG.0000000000002432
Contents: Original Research

OBJECTIVE: To quantify the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries over a 5-year period in New York City adjusting for other sociodemographic and clinical factors.

METHODS: We conducted a population-based cross-sectional study using linked birth certificates and hospital discharge data for New York City deliveries from 2008 to 2012. Severe maternal morbidity was defined using a published algorithm of International Classification of Diseases, 9th Revision, Clinical Modification disease and procedure codes. Hospital costs were estimated by converting hospital charges using factors specific to each year and hospital and to each diagnosis. These estimates approximate what it costs the hospital to provide services (excluding professional fees) and were used in all subsequent analyses. To estimate adjusted mean costs associated with severe maternal morbidity, we used multivariable regression models with a log link, gamma distribution, robust standard errors, and hospital fixed effects, controlling for age, race and ethnicity, neighborhood poverty, primary payer, number of deliveries, method of delivery, comorbidities, and year. We used the adjusted mean cost to determine the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries from 2008 to 2012.

RESULTS: Approximately 2.3% (n=13,502) of all New York City delivery hospitalizations were complicated by severe maternal morbidity. Compared with nonsevere maternal morbidity deliveries, these hospitalizations were clinically complicated, required more and intensive clinical services, and had a longer stay in the hospital. The average cost of delivery with severe maternal morbidity was $14,442 (95% CI $14,128–14,756), compared with $7,289 (95% CI $7,276–7,302) among deliveries without severe maternal morbidity. After adjusting for other factors, the difference between deliveries with and without severe maternal morbidity remained high ($6,126). Over 5 years, this difference resulted in approximately $83 million in total excess costs (13,502×$6,126).

CONCLUSION: Severe maternal morbidity nearly doubled the cost of delivery above and beyond other drivers of cost, resulting in tens of millions of excess dollars spent in the health care system in New York City. These findings can be used to demonstrate the burden of severe maternal morbidity and evaluate the cost-effectiveness of interventions to improve maternal health.

Severe maternal morbidity has important consequences for women's health and the health care system in New York City, nearly doubling hospital delivery costs and contributing millions in excess costs.

New York City Department of Health and Mental Hygiene, Long Island City, New York; and New York City Health+Hospitals/Kings County, Brooklyn, New York.

Corresponding author: Renata E. Howland, MPH, NYC Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 10010; email:

Supported by a grant from Merck, through its Merck for Mothers Program and managed by the Fund for Public Health in New York, Inc. Merck had no role in the study design, collection, analysis, interpretation of the data, or writing of the manuscript.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.