Costs of Gestational Hypertensive Disorders in California: Hypertension, Preeclampsia, and Eclampsia

Gestational hypertensive disorders are a major public health concern nationally and in California, and significant effort is directed towards preventing morbidity and mortality from these conditions. The rising rates of risk factors, including obesity, maternal age, and diabetes, may lead to an increase in the rate of gestational hypertensive disorders. Appropriate management can reduce the significant societal and cost burden of these conditions. With approximately half a million births annually in California, nearly half of which are paid by Medi-Cal, the costs of gestational hypertensive disorders are of particular concern to the Medi-Cal program. Assessing the magnitude of the preventable expenditures due to gestational hypertensive disorders may aid in the widespread implementation of evidence‐based guidelines and reduction of these avoidable expenditures.

In this report, the authors identify the probabilities of various forms of gestational hypertensive disorders and use these probabilities to develop the likelihood of various maternal and neonatal outcomes given the severity of gestational hypertensive disorders, gestational age, and type of delivery. They also develop cost scenarios associated with these outcomes for the mother and the baby, using publicly available data from the Medi-Cal, fee-for-service (FFS) fee schedule and reimbursement rates to private hospitals in California to develop costs. They then estimate the average cost per uncomplicated delivery and the incremental cost per delivery complicated by gestational hypertensive disorders and calculate the overall incremental medical costs of these disorders for the Medi‐Cal program. The findings presented in this report are based on conservative estimates of costs and use of resources, and are likely to be the lower‐bound estimates of probabilities and costs of gestational hypertensive disorders.   A related report (see below) examines the costs of maternal hemorrhage in California. This report was developed with funding from the California Department of Public Health, Maternal, Child and Adolescent Health Division.

Publication Authors:

• Nadereh Pourat, PhD
• Ana E. Martinez, MPH
• Jenna Jones, MPH
• Kimberly D. Gregory
• Lisa Korst
• Gerald F. Kominski, Ph.D.