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 reduci ng congenital anomalies in infants born of mothers with pre-existing d iabetes mellitus. RESEARCH DESIGN AND METHODS - This study used litera ture review, consensus development among an expert panel of physicians , and surveys of medical care personnel to obtain information about th e costs and consequences of preconception plus prenatal care compared with prenatal care only for women with established diabetes. Preconcep tion care involves close interaction between the patient and an interd isciplinary health-care team as well as intensified evaluation, follow -up, testing, and monitoring. The outcome measures assessed in this st udy are the medical costs of preconception care versus prenatal care o nly and the benefit-cost ratio. RESULTS- The costs of preconception pl us prenatal care are $17,519/delivery, whereas the costs of prenatal c are only are $13,843/delivery. Taking into account maternal and neonat al adverse outcomes, the net savings of preconception care are $1720/e nrollee over prenatal care only and the benefit-cost ratio is 1.86. Th e preconception care program remained cost saving across a wide range of assumptions regarding incidence of adverse outcomes and program cos t components. CONCLUSIONS - Despite significantly higher per delivery costs for participants in a hypothetical preconception care program, i ntensive medical care before conception resulted in cost savings compa red with prenatal care only. Third- party payers can expect to realize cost savings by reimbursing preconception care in this high-risk popu lation.