Ab1414 the Cost of Prenatal Care in Women With Rheumatic Diseases.

Abstract

BackgroundIn Mexico, over 60% of the population is uninsured and not able to afford private healthcare services. Women with autoimmune rheumatic diseases (ARDs) are a high-risk group during pregnancy. Morbidity associated with ARDs and pregnancy can include lower birth weight, increased preterm delivery, and more emergency cesarean sections than pregnant women without ARDs. Close monitoring and multidisciplinary care are necessary to prevent and timely treat complications, on the other hand these health interventions are not available to all women with ARDs because of the high prices that it represents.ObjectivesThe aim of this study was to estimate the cost of prenatal care in women with ARDs without health insurance in Northeast Mexico.MethodsTo assess the costs of prenatal care of women with ARDs in the Northeast of Mexico from the perspective of a women without any health insurance, we estimated only the direct costs of the mandatory medical follow-up. Direct costs are all healthcare costs that are directly related to the consultations with a multidisciplinary team, serological and immune laboratory test, and ultrasounds per trimester. All costs and medical fees were obtained from a university hospital in Monterrey, Mexico. To assess the impact of prenatal care in real life, we compared the health expenditure per trimester reported by the pregnancy and rheumatic diseases clinic from the same institution. The data is presented in USD. We were not able to assess indirect costs related to health coverage (like transportation) and specific medical treatment (antirheumatic drugs or other interventions).ResultsThe mean cost for medical consultations and ultrasounds per trimester was $184-277 USD. The average cost of immune test and general lab test ranges from $424-428 USD. The total cost per trimester was from $608 to 705 USD, and the direct cost per three trimesters was $1824-2115 USD.The average family income per month was $614.23 USD and the average health expenditure (per month) was 105.71 USD; which represents 16.21% of the family income. The average family health expenditure per trimester was $317.13 USD.ConclusionThe total cost for prenatal care per trimester was calculated in $608 to 705 USD. The cost of prenatal care per trimester is 193.69% higher than the average health expenditure per trimester for uninsured women with ARDs. More and new strategies are needed to solve and reduce inequalities in access to health.Table 1.Average cost of prenatal care per trimesterMedical consultations and ultrasoundsMedical ConsultationsCosts (USD)FrecuencyCOST PER TRIMESTER $184-277 USDRheumatologist$13MonthlyGenetics$49At least oneObtetrician$14MonthlyUS 1st Trimester$54Only one timeUS 2nd Trimester$49Only one timePsychologist$39If neededNutritionist$5If neededClinical testClinical testCosts (USD)FrecuencyCOST PER TRIMESTER $188 USDComplete Blood Count$9One per trimesterBlood Chemistry$38One per trimesterVitamin D (25-OH)$59One per trimesterThyroid profile test$16One per trimesterPT, TTP$36One per trimesterProtein C reactive$20One per trimesterErythrocyte sedimentation rate$5One per trimesterUrine general test$5One per trimesterImmune lab test (For patients with rheumatoid arthritis and spondylarthritis)Immune lab testCosts (USD)FrecuencyCOST PER TRIMESTER $240 USDRheumatoid factor$24One per trimesterAnti-CCP$33One per trimesterAnti SS-A/RO$19One per trimesterAnti-SS-B/LA$19One per trimesterAnticardiolipins$33One per trimesterBeta-2-glycoprotein$66One per trimesterLupus anticoagulant$46One per trimesterImmune lab test (For patients with lupus, antiphospholipid syndrome, Sjogren’s syndrome, vasculitis, and others) (Others: rheumatic skin and muscle diseases,)Immune lab testCosts (USD)FrecuencyCOST PER TRIMESTER $236 USDAnti-SS-A/RO$21One per trimesterAnti-SS-B/LA$21One per trimesterAnticardiolipins$33One per trimesterBeta-2-glycoprotein$66One per trimesterLupus anticoagulant$46One per trimesterAnti-DNA$24One per trimesterAntinuclear antibodies$25One per trimesterDisclosure of InterestsNone declared

Health Equity in Rheumatology: A Global Health Perspective

“…14 Taken together, it is no surprise that the average cost of prenatal care for females with rheumatic disorders is almost twice the cost of that for those who do not have the disease. 15 These disparities in disease presentation contribute to health inequities related to financial costs and avoidable maternal and foetal complications.…”