Economic Burden of Adverse Perinatal Outcomes in High-Income Countries: A Systematic Review

OBJECTIVES: Adverse perinatal outcomes impose considerable economic burden at the individual, health care system and societal level and has received less attention in high-income countries. We systematically and comprehensively reviewed the economic burden of adverse perinatal outcomes from birth to early childhood period.

METHODS: We used EconLit, MEDLINE, EMBASE, CINAHL, and PubMed databases to search peer-reviewed articles from 2010 onwards and published in English language. We included studies reporting on the costs associated with at least one of the adverse perinatal outcomes. We quantified the overall costs and sub-group costs. We used the consumer pricing index to adjust costs for inflation in each specific country and purchasing power parity to convert all costs into a common currency (USD) in 2022 value.

RESULTS: We included 81 studies conducted in 18 countries. Our findings revealed that the median costs associated with adverse perinatal outcomes was 37,544 USD (IQR: 103,583) (2022 value), contributed by median costs associated with preterm 15,683 USD (IQR: 80,109 USD), congenital anomalies 68,421 USD (IQR: 109,337 USD), and the mean health care costs of stillbirths was 9,128 USD (SD: 5,165 USD). Notably, almost 98% of the total cost comprised health system costs (direct medical and non-medical). Preterm births and congenital anomalies accounted for more than four-fifths of the total cost.

CONCLUSIONS: We observed significantly higher health system costs associated with births experiencing adverse outcomes. So, an investment in improving neonatal outcomes is a valuable contribution towards savings in the health system in later years. Therefore, key actors involved in the perinatal health care should emphasis efforts to avert adverse outcomes, consequently reducing the economic burden.