Katy B. Kozhimannil|Rachel R. Hardeman|Fernando Alarid?Escudero|Carrie A. Vogelsang|Cori Blauer?Peterson|Elizabeth A. Howell
Modeling the Cost?Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery
Minnesota Department of Health|University of Minnesota|Mayo Clinic in Florida|University of Minnesota|Minnesota Department of Health|Minnesota Department of Health|University of Minnesota|University of Minnesota|Minnesota Department of Health|Icahn School of Medicine at Mount Sinai
abstract background one nine us infants born 37 weeks gestation incurring medical costs 10 times higher fullterm infants one three infants born cesarean cesarean births cost twice much vaginal births compared rates preterm cesarean birth among medicaid recipients prenatal access doula care nonmedical maternal support similar women regionally used data association mathematically model potential costeffectiveness medicaid coverage doula services methods data came two sources medicaidfunded singleton births hospitals west north central east north central us n 65147 2012 nationwide inpatient sample medicaidfunded singleton births n 1935 supported communitybased doula organization upper midwest 2010 2014 analyzed routinely collected deidentified administrative data multivariable regression analysis used estimate associations doula care outcomes probabilistic decisionanalytic model used costeffectiveness estimates results women received doula support lower preterm cesarean birth rates medicaid beneficiaries regionally 47 vs 63 204 vs 342 adjustment covariates women doula care 22 percent lower odds preterm birth aor 077 95 ci 061096 costeffectiveness analyses indicate potential savings associated doula support reimbursed average 986 ranging 929 1047 across states conclusions based associations doula care preterm cesarean birth coverage reimbursement doula services would likely cost saving costeffective state medicaid programs