Multiple births associated with increased healthcare costs

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1. Multiple births were more likely to require longer hospitalization and NICU admission than singleton deliveries. 

2. Multiple birth deliveries were associated with increased healthcare costs for both mother and child. 

Evidence Rating Level: 2 (Good)            

Study Rundown: This study found that women with multiple deliveries have substantially increased healthcare costs. Past studies have focused primarily on multiple birth delivery outcomes following assisted reproductive technology (ART) treatments. The present work adds to the existing literature by examining both ART and non-ART multiple births and evaluating costs over a longer follow-up period.

Limitations of the study include retrospective design and inclusion of only women with employer-based insurance coverage. Additionally, the increased likelihood of systemic and reproductive comorbidities in mothers with multiple gestations may confound maternal costs associated with multiple birth deliveries. Future work might include a prospective study and include uninsured women and women with other insurance coverage to increase generalizability and provide more insight into the financial impact of multiple births.

Click to read the study in AJOG

Relevant Reading: Preterm deliveries that result from multiple pregnancies associated with assisted reproductive technologies in the USA: a cost analysis

In-Depth [retrospective study]: This study used commercial claims and encounters data for singleton (n=424,880), twin (n=12,482) and higher multiple (n=562) deliveries to evaluate differences in healthcare costs. Outcomes evaluated included cost incurred by care of the mother from 27 weeks gestation to 4 weeks post-partum and costs incurred by care of the infant(s) in the period from birth until their 1^st birthday.

Multiple births were more likely require longer hospital stays (13.4 days for higher multiples vs. 3.3 days for singletons) and intensive care admission (OR 10.9, CI 10.4-11.4 for twins; OR 31.1, CI 26.3-36.7 for higher multiples). Average all-cause health care costs were $21,458 for singleton deliveries, $104,831 for twin deliveries and $407,199 for higher multiple deliveries.

By Denise Pong, MPH and Leah Hawkins, MD, MPH

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