Economic consequences of over-diagnosis of threatened preterm labor

Abstract

Objective: To investigate whether adherence to a cervical length-based protocol can reduce both unnecessary admissions and the socioeconomic costs associated with inappropriately admitted patients. Methods: The present retrospective observational study included women admitted for threatened preterm labor (TPL) at 24–34 weeks of pregnancy to a tertiary hospital in the Canary Islands, 2009–2014. Data were reviewed from all patients admitted for TPL. Those with a long cervix (>25 mm) were classified as “inappropriate admissions”, and both the economic burden based on diagnosis-related group (DRG) and the social costs associated with sick leave for these women were calculated. Results: During the 6-year study period, 430 women were admitted for TPL. The rate of inappropriate hospital admissions was 45% in the first year, but was reduced to 23% in the final year (P<0.001); the premature delivery rates in these years did not differ (P=0.224). The mean DRG-based cost of the admission per patient with a long cervix was EU euros €2099. The total annual costs from inappropriate admission (both social security sick leave costs and hospital costs) were estimated to be up to €571 047.37 during the 6-year study period, and reduced from €60 420.76 in 2009 to €29 998.04 in 2014. Conclusion: Reductions in inappropriate admissions from applying cervical length-based management protocol could reduce healthcare costs without increasing the incidence of premature delivery.