Indirect Costs Associated with Preterm Birth in the United States

OBJECTIVES:

The economic burden of workplace productivity loss (WPL) due to preterm birth (PTB) has not been quantified. This is the first comparative study to estimate the indirect costs associated with WPL due to PTB in the United States.

METHODS:

Data for individuals who delivered a live birth at ≥23 weeks gestational age (wGA) (index date) were extracted from MarketScan Commercial Claims (January 2016–September 2021). Inclusion criteria were: age 18–55 years, primary insurance beneficiary, and continuous enrollment ≥6 months pre- and ≥12 months post-index. Individuals were divided into PTB (<37 wGA) and full-term birth (FTB) (≥37 wGA) cohorts that were propensity-score matched on pre-specified baseline covariates for each endpoint: medically-related absenteeism (emergency or inpatient [1 day] or outpatient [0.5 day] visit), workplace absenteeism (sick, vacation, recreational leave; Family Medical Leave Act [FMLA]), disability (short- and long-term), and overall WPL. Per-patient indirect costs are reported based on national wage estimates (2021 USD) in the year following delivery.

RESULTS:

At baseline, cohorts for medically-related absenteeism (n=37,522), workplace absenteeism (n=1,028), disability (n=7,880), and overall WPL (n=396) were well matched. In the main analysis, PTB was associated with significantly higher indirect costs due to medically-related absenteeism ($1,045) and disability ($422) than FTB (both p<0.001); a sensitivity analysis (conservative definition of workplace absenteeism: sick leave and FMLA) showed PTB was associated with significantly higher indirect costs due to overall WPL than FTB ($1,093; p<0.012). Subgroup analyses showed early PTB (<34 wGA or <32 wGA) was associated with higher indirect costs due to medically-related absenteeism ($2,140 or $2,649, respectively) and overall WPL ($1,796 or $3,206, respectively) than FTB. Other differences were not statistically significant.

CONCLUSIONS:

PTB was associated with notable indirect costs due to WPL in the year following delivery. Prolongation of pregnancy could result in indirect cost savings for United States employers.