Wednesday, December 19, 2012

Cost-Effectiveness of Preventing Complications of Childbirth

Back on December 10, the Wall Street Journal had an article on the increasing incidence of complications at childbirth and commented on this could be related to the increase in age of the mother in many cases, obesity, and mothers having other chronic conditions.  Although the article was quick to point out that complications were not confined only to women with complicated health of their own and that otherwise perfectly healthy mothers could also have severe complications.

The article also pointed out that most safe birth initiatives in the past had focused on preventing harm to the infant.

What is interesting about this from a cost-effectiveness perspective is the question of whose benefits are counted.  In general, when it comes to birth we should count both the mother and the child.  And, not only would we want to count each of them, but we might also want to find a way to recognize that their health is closely intertwined.  For example, a mother losing a child could have a long-term effect on the mother's mental health.  And, if it affects her mental health it could also have an impact on her physical health.  The same might be said of an infant losing her mother.

When we see sophisticated cost-effectiveness analyses that calculate and use quality adjusted life years, we find that usually this focuses on a single target group.  In this case the mothers (if we are focusing on preventing or dealing with complications of birth) or the children (if we are focusing on the child's health immediately after delivery).  What we rarely see in the literature is the combination of the two.  And what we see even more rarely would be an explicit recognition of how the two are not just correlated but so closely interrelated.  A loss of health related quality of life or life years for one member of the mother-child pair is likely to have a critical impact on the other.  This is an interesting frontier to think about and to consider how acknowledging the impact on both members of a pair might make specific interventions looks like a better value as the impact is increased by considering the effects on two individuals.   

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