Decision and economic analysis of hostile abortion laws compared with supportive abortion laws.
Citation: American Journal of Obstetrics & Gynecology MFM. :101019, 2023 May 11PMID: 37178721Institution: MedStar Washington Hospital Center | Obstetrics and Gynecology/Family PlanningForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXED | Year: 2023ISSN:- 2589-9333
| Item type | Current library | Collection | Call number | Status | Date due | Barcode |
|---|---|---|---|---|---|---|
| Journal Article | MedStar Authors Catalog | Article | 37178721 | Available | 37178721 |
BACKGROUND: On June 24, 2022, the US Supreme Court overturned Roe v. Wade in Dobbs v. Jackson Women's Health Organization. As a result, several states banned abortion, and others are considering more hostile abortion laws.
CONCLUSION: When states consider enacting hostile abortion laws, legislators should consider an increase in the incidence of adverse maternal and neonatal outcomes. Copyright � 2023. Published by Elsevier Inc.
OBJECTIVE: To assess the incidence of adverse maternal and neonatal outcomes in the hypothetical cohort where all states have hostile abortion laws compared to the pre-Dobbs v. Jackson cohort (supportive abortion laws cohort) and examine the cost-effectiveness of these policies.
RESULTS: In the base case analysis, the hostile abortion laws cohort compared to the supportive abortion laws cohort had 12911 more maternal mortality, 7518 more hysterectomies, 234376 more cesarean deliveries, 102712 more hospital readmissions, 83911 more NICU admissions, 3311 more neonatal mortality, and 904 more cases of profound neurodevelopmental disability. The hostile abortion laws cohort compared with the supportive abortion laws cohort was associated with more cost ( 09.8 billion vs. 5.6 billion) and 120749900 fewer QALY with an ICER of negative 40687.6. Probabilistic sensitivity analyses suggested that the chance of the supportive abortion laws cohort being the preferred strategy was more than 95%.
STUDY DESIGN: We developed a decision and economic analysis model comparing the hostile abortion laws cohort with the supportive abortion laws cohort in a sample of 5.3 million pregnancies. Cost (inflated to 2022 USD) estimates were from a healthcare provider's perspective including immediate and long-term costs. The time horizon was set to a lifetime. Probabilities, costs, and utilities were derived from the literature. The cost-effectiveness threshold was set to be at 00,000 per quality-adjusted life-year (QALY). Probabilistic sensitivity analyses using Monte Carlo simulation with 10,000 simulations were performed to assess the robustness of our results. Primary outcomes included maternal mortality and an incremental cost-effectiveness ratio (ICER). Secondary outcomes included hysterectomy, cesarean delivery, hospital readmission, neonatal intensive care unit (NICU) admission, neonatal mortality, and profound neurodevelopmental disability as well as the incremental cost and effectiveness.
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