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State Perinatal Quality Collaborative for Reducing Severe Maternal Morbidity From Hemorrhage: A Cost-Effectiveness
Erik C Wiesehan1, Sirina R Keesara, Jill R Krissberg
1Department of Health Policy and the Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, and Highland Hospital, Alameda Health System, Oakland, California; and the Department of Pediatrics, Northwestern University Fienberg School of Medicine, Chicago, Illinois.
California's initiative to reduce severe maternal morbidity from hemorrhage is cost-effective. This quality improvement effort averts maternal morbidity and mortality, saving millions and improving patient outcomes.
Area of Science:
- Maternal Health
- Health Economics
- Quality Improvement Science
Background:
- Severe maternal morbidity (SMM) from hemorrhage poses a significant risk to birthing individuals.
- California's Maternal Quality Care Collaborative (CMQCC) implemented a statewide initiative to reduce hemorrhage-related SMM.
- Evaluating the cost-effectiveness of such quality improvement initiatives is crucial for healthcare policy and resource allocation.
Purpose of the Study:
- To evaluate the cost-effectiveness of California's statewide perinatal quality collaborative initiative for reducing severe maternal morbidity (SMM) due to hemorrhage.
- To assess the impact on both short-term and long-term costs and outcomes.
- To determine if the initiative represents a valuable investment in maternal healthcare.
Main Methods:
- A decision-analytic model was developed using open-source software (Amua 0.30).
- The model simulated a cohort of 480,000 births to assess the annual effect in California.
- Data from literature and select hospitals were used to estimate costs and intervention effectiveness, with sensitivity analyses performed.
Main Results:
- The collaborative initiative was found to be cost-effective, demonstrating strong dominance over the standard of care.
- Implementation averted 913 cases of SMM, 28 emergency hysterectomies, and one maternal mortality, adding 182 quality-adjusted life-years (QALYs).
- The initiative saved approximately $9 million, and remained cost-effective across various sensitivity analyses and scenarios.
Conclusions:
- California's statewide perinatal quality collaborative initiative to reduce SMM from hemorrhage is a cost-effective quality-improvement strategy.
- The initiative effectively reduces maternal morbidity and mortality.
- It offers potential cost savings for birthing hospitals, representing an inexpensive yet impactful intervention.
