ECONOMIC BURDEN OF NAUSEA AND VOMITING OF PREGNANCY IN THE USA
Main Article Content
Keywords
Cost, burden, nausea, NVP, pregnancy, vomiting
Abstract
Background
Nausea and vomiting of pregnancy (NVP) is the most common medical condition during gestation, affecting 50%-90% of women during their first trimester, and many in the second and third trimester. NVP affects women’s quality of life and exerts a large economic impact on patients, caregivers and society.
Objectives
To estimate the overall economic burden of illness of NVP in the USA.
Methods
A spreadsheet model was utilized to estimate this burden including direct and indirect costs. Costs are reported in 2012 US dollars and were estimated from the perspective of society. Cost centers included drug treatments for mild to severe NVP and hospitalizations for hyperemesis gravidarum (HG), as well as time lost from work and caregiver time. Clinical, epidemiologic, and economic data were obtained from the literature to populate the model. Rates of drug use were multiplied by unit costs and summed.
Results
The estimated total economic burden in 2012 in the USA was $1,778,473,782 which included $1,062,847,276 (60%) in direct costs and $715,626,506 (40%) in indirect costs. Overall, the average cost to manage one woman for NVP was $1827. Costs increased with increasing severity of NVP. The estimates were conservative, as not all applicable costs could be included.
Conclusions
NVP results in a significant economic impact, and hence effective therapy should be sought. Future prospective research should determine in more detail what resources are utilized in the USA to manage women with NVP.
References
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5. Caredwell MS. Pregnancy sickness: a biopsychological perspective. Obstet Gynecol Surv 2012;67:645-52.
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7. Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol 2006;107:277-84.
8. Bashiri A, Neumann L, Maymon E, Katz M. Hyperemesis gravidarum: epidemiologic features, complications and outcome. Eur J Obstet Gynecol Reprod Biol 1995;63:135-8.
9. Goodwin TM. Hyperemesis gravidarum. Obstet Gynecol Clin North Am 2008;35:401-17.
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11. Gazmararian JA, Petersen R, Jamieson DJ, et al. Hospitalizations during pregnancy among managed care enrollees. Obstet Gynecol 2002;100:94-100.
12. Bacak SJ. Callaghan WM. Dietz PM. et al. Pregnancy associated hospitalizations in the United States, 1999–2000. Am J Obstet Gynecol 2005;192:592-7.
13. Attard CL, Kohli MA, Coleman S, et al. The burden of illness of severe nausea and vomiting of pregnancy in the United States. Am J Obstet Gynecol 2002;186:S220-7.
14. Mazzotta P, Stewart D, Atanackovic G, Koren G, Magee LA. Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy. J Psychosom Obstet Gynaecol 2000;21:129-36.
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16. Smith C, Crowther C, Beilby J, Dandeaux J. The impact of nausea and vomiting on women: a burden of early pregnancy. Aust N Z J Obstet Gynaecol 2000;40:397-401.
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29. Mazzotta P, Magee LA. A risk-benefit assessment of pharmacological and nonpharmacological treatments for nausea and vomiting of pregnancy. Drugs 2000;59:781-800.
30. Reichmann JP, Kirkbride MS. Reviewing the evidence for using continuous subcutaneous metoclopramide and ondansetron to treat nausea and vomiting during pregnancy. Manag Care 2012; 21:44-7.
31. IMS Brogan data on file. 2013.
32. US Social Security Administration. National average wage index. Available at: http://wwwssagov/oact/cola/AWIhtml [Accessed 20 Dec 2012].
33. Sahakian V, Rouse D, Sipes S, Rose N, Niebyl J. Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study. Obstet Gynecol 1991;78:33-6.
34. Sullivan CA, Johnson CA, Roach H, Martin RW, Stewart DK, Morrison JC. A pilot study of intravenous ondansetron for hyperemesis gravidarum. Am J Obs Gynecol 1996;174:1565-8.
35. Safari HR, Fassett MJ, Souter IC, Alsulyman OM, Goodwin TM. The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: a randomized, double-blind, controlled study. Am J Obstet Gynecol 1998;179:921-4.
36. Bsat FA, Hoffman DE, Seubert DE. Comparison of three outpatient regimens in the management of nausea and vomiting in pregnancy. J Perinatol 2003;23:531-5.
37. Adamczak J, Kasdaglis J, Rinehart B, Antebi Y, Wolf E, Terrone D. A prospective randomized trial of solumedrol dose pack vs. phenergan for the treatment of symptomatic nausea and vomiting in pregnancy. Am J Obstet Gynecol 2008;197:S88.
38. Koren G, Clark S, Hankins GDV, et al. Effectiveness of delayed-release doxylamine and pyridoxine for nausea and vomiting of pregnancy: a randomized placebo controlled trial. Am J of Obstet Gynecol 2010;203:571.e1-7.
39. American Pregnancy Association. Statistics - pregnancy. available at: http://wwwamericanpregnancyorg/main/statisticshtml [Accessed: 20 Dec 2012].
40. Stephanie J. Ventura MA. Sally C. Estimated Pregnancy Rates and Rates of Pregnancy Outcomes for the United States, 1990–2008. National Vital Statistics Reports - available at: http://wwwcdcgov/nchs/data/nvsr/nvsr60/nvsr60_07pdf 2012;60:1-20.
41. Naumann CR, Zelig C, Napolitano PG, Ko CW. Nausea, vomiting, and heartburn in pregnancy: a prospective look at risk, treatment, and outcome. J Matern Fetal Neonatal Med 2012;25:1488-93.
42. Kullander S, Kallen B. A prospective study of drugs and pregnancy. II. Anti-emetic drugs. Acta Obstet Gynecol Scand 1976;55:105-11.
43. Belluomini J, Litt RC, Lee KA, Katz M. Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Obstet Gynecol 1994;84:245-8.
44. Steele NM, French J, Gatherer-Boyles J, Newman S, Leclaire S. Effect of acupressure by Sea-Bands on nausea and vomiting of pregnancy. J Obstet Gynecol Neonatal Nurs 2001;30:61-70.
45. Czeizel AE, Dudas I, Fritz G, Tecsoi A, Hanck A, Kunovits G. The effect of periconceptional multivitamin-mineral supplementation on vertigo, nausea and vomiting in the first trimester of pregnancy. Arch Gynecol Obstet 1992;251:181-5.
46. Koren G, Maltepe C. Preventing recurrence of severe morning sickness. Can Fam Physician 2006;52:1545-6.
47. Koren G, Maltepe C. Pre-emptive therapy for severe nausea and vomiting of pregnancy and hyperemesis gravidarum. J Obstet Gynaecol 2004;24:530-3.
48. Semmens JP. Hyperemesis gravidarum; evaluation and treatment. Obstet Gynecol 1957;9:586-94.
49. Crystal SR, Bowen DJ, Bernstein IL. Morning sickness and salt intake, food cravings, and food aversions. Physiol Behav 1999;67:181-7.
50. Evans AT, Samuels SN, Marshall C, Bertolucci LE. Suppression of pregnancy-induced nausea and vomiting with sensory afferent stimulation. J Reprod Med 1993;38:603-6.
51. Keating A, Chez RA. Ginger syrup as an antiemetic in early pregnancy. Altern Ther Health Medicine 2002;8:89-91.
52. Rosen T, de Veciana M, Miller HS, Stewart L, Rebarber A, Slotnick RN. A randomized controlled trial of nerve stimulation for relief of nausea and vomiting in pregnancy. Obstet Gynecol 2003; 102:129-35.
53. Yost NP, McIntire DD, Wians FH, Jr., Ramin SM, Balko JA, Leveno KJ. A randomized, placebo-controlled trial of corticosteroids for hyperemesis due to pregnancy. Obstet Gynecol 2003; 102:1250-4.
2. Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy.[Erratum appears in Br J Gen Pract]1993;43:245-8.
3. Vellacott ID, Cooke EJ, James CE. Nausea and vomiting in early pregnancy. Int J Gynaecol Obstet 1988;27:57-62.
4. Sherman PW. Flaxman SM. Nausea and vomiting of pregnancy in an evolutionary perspective. Am J Obstet Gynecol 2002;186:S190-S7.
5. Caredwell MS. Pregnancy sickness: a biopsychological perspective. Obstet Gynecol Surv 2012;67:645-52.
6. Lacroix R, Eason E, Melzack R. Nausea and vomiting during pregnancy: A prospective study of its frequency, intensity, and patterns of change. Am J Obstet Gynecol 2000;182:931-7.
7. Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol 2006;107:277-84.
8. Bashiri A, Neumann L, Maymon E, Katz M. Hyperemesis gravidarum: epidemiologic features, complications and outcome. Eur J Obstet Gynecol Reprod Biol 1995;63:135-8.
9. Goodwin TM. Hyperemesis gravidarum. Obstet Gynecol Clin North Am 2008;35:401-17.
10. Reichmann JP, Kirkbride MS. Nausea and vomiting of pregnancy: cost effective pharmacologic treatments. Manag Care 2008;17:41-5.
11. Gazmararian JA, Petersen R, Jamieson DJ, et al. Hospitalizations during pregnancy among managed care enrollees. Obstet Gynecol 2002;100:94-100.
12. Bacak SJ. Callaghan WM. Dietz PM. et al. Pregnancy associated hospitalizations in the United States, 1999–2000. Am J Obstet Gynecol 2005;192:592-7.
13. Attard CL, Kohli MA, Coleman S, et al. The burden of illness of severe nausea and vomiting of pregnancy in the United States. Am J Obstet Gynecol 2002;186:S220-7.
14. Mazzotta P, Stewart D, Atanackovic G, Koren G, Magee LA. Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy. J Psychosom Obstet Gynaecol 2000;21:129-36.
15. Piwko C, Ungar WJ, Einarson TR, Wolpin J, Koren G. The weekly cost of nausea and vomiting of pregnancy for women calling the Toronto Motherisk Program. Curr Med Res Opin 2007;23:833-40.
16. Smith C, Crowther C, Beilby J, Dandeaux J. The impact of nausea and vomiting on women: a burden of early pregnancy. Aust N Z J Obstet Gynaecol 2000;40:397-401.
17. O'Brien B, Naber S. Nausea and vomiting during pregnancy: effects on the quality of women's lives. Birth 1992;19:138-43.
18. Bailit JL. Hyperemesis gravidarium: Epidemiologic findings from a large cohort. Am J Obstet Gynecol 2005;193:811-4.
19. Gadsby R, Barnie-Adshead AM. Nausea and vomiting of pregnancy: clinical information about nausea and vomiting of pregnancy and its relation to various aspects of womens’ personal and obstetric histories and other significant factors related to nausea and vomiting of pregnancy or hyperemesis gravidarum. A literature review. Available at: http://www.pregnancysicknesssupport.org.uk/documents/NVP-lit-review.pdf [Accessed: 28 Jan 2013].
20. ACOG. Nausea and vomiting of pregnancy. Obstet Gynecol 2004 Pract Bull No 52; 103:803-14.
21. Einarson TR, Piwko C, Vicente C, Koren G. Quantifying the global rates of nausea and vomiting of pregnancy: A meta-analysis. J SOGC. 2013.Submitted.
22. Red Book.Truven Health Analytics. Available at: http://wwwredbookcom/redbook/ [Accessed: 28 Jan 2013].
23. Healthcare Cost and Utilization Project (HCUP). Available at http://www.hcup-us.ahrq.gov/ . [Accessed: 20 Dec 2012]. .
24. Agency for Healthcare Research and Quality. Information on ED visits from the HCUP Nationwide Emergency Department Sample (NEDS) Available at: http://hcupnetahrqgov/HCUPnetjsp [Accessed: 20 Dec 2012].
25. Index Mundi. United States demographics: Birth Rate. Available at http://www.indexmundi.com/g/g.aspx?c=us&v=25. [Accessed: 30 Jan 2013].
26. Chatterjee S, Kotelchuck M, Sambamoorthi U. Prevalence of chronic illness in pregnancy, access to care, and health care costs: implications for interconception care. Womens Health Issues 2008;18:S107-16.
27. Laugesen MJ, Glied SA. Higher fees paid to US physicians drive higher spending for physician services compared to other countries. Health Aff (Millwood) 2011;30:1647-56.
28. Index Mundi. United States Inflation rate (consumer prices). Available at: http://wwwindexmundicom/united_states/inflation_rate_(consumer_prices)html.
29. Mazzotta P, Magee LA. A risk-benefit assessment of pharmacological and nonpharmacological treatments for nausea and vomiting of pregnancy. Drugs 2000;59:781-800.
30. Reichmann JP, Kirkbride MS. Reviewing the evidence for using continuous subcutaneous metoclopramide and ondansetron to treat nausea and vomiting during pregnancy. Manag Care 2012; 21:44-7.
31. IMS Brogan data on file. 2013.
32. US Social Security Administration. National average wage index. Available at: http://wwwssagov/oact/cola/AWIhtml [Accessed 20 Dec 2012].
33. Sahakian V, Rouse D, Sipes S, Rose N, Niebyl J. Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study. Obstet Gynecol 1991;78:33-6.
34. Sullivan CA, Johnson CA, Roach H, Martin RW, Stewart DK, Morrison JC. A pilot study of intravenous ondansetron for hyperemesis gravidarum. Am J Obs Gynecol 1996;174:1565-8.
35. Safari HR, Fassett MJ, Souter IC, Alsulyman OM, Goodwin TM. The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: a randomized, double-blind, controlled study. Am J Obstet Gynecol 1998;179:921-4.
36. Bsat FA, Hoffman DE, Seubert DE. Comparison of three outpatient regimens in the management of nausea and vomiting in pregnancy. J Perinatol 2003;23:531-5.
37. Adamczak J, Kasdaglis J, Rinehart B, Antebi Y, Wolf E, Terrone D. A prospective randomized trial of solumedrol dose pack vs. phenergan for the treatment of symptomatic nausea and vomiting in pregnancy. Am J Obstet Gynecol 2008;197:S88.
38. Koren G, Clark S, Hankins GDV, et al. Effectiveness of delayed-release doxylamine and pyridoxine for nausea and vomiting of pregnancy: a randomized placebo controlled trial. Am J of Obstet Gynecol 2010;203:571.e1-7.
39. American Pregnancy Association. Statistics - pregnancy. available at: http://wwwamericanpregnancyorg/main/statisticshtml [Accessed: 20 Dec 2012].
40. Stephanie J. Ventura MA. Sally C. Estimated Pregnancy Rates and Rates of Pregnancy Outcomes for the United States, 1990–2008. National Vital Statistics Reports - available at: http://wwwcdcgov/nchs/data/nvsr/nvsr60/nvsr60_07pdf 2012;60:1-20.
41. Naumann CR, Zelig C, Napolitano PG, Ko CW. Nausea, vomiting, and heartburn in pregnancy: a prospective look at risk, treatment, and outcome. J Matern Fetal Neonatal Med 2012;25:1488-93.
42. Kullander S, Kallen B. A prospective study of drugs and pregnancy. II. Anti-emetic drugs. Acta Obstet Gynecol Scand 1976;55:105-11.
43. Belluomini J, Litt RC, Lee KA, Katz M. Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Obstet Gynecol 1994;84:245-8.
44. Steele NM, French J, Gatherer-Boyles J, Newman S, Leclaire S. Effect of acupressure by Sea-Bands on nausea and vomiting of pregnancy. J Obstet Gynecol Neonatal Nurs 2001;30:61-70.
45. Czeizel AE, Dudas I, Fritz G, Tecsoi A, Hanck A, Kunovits G. The effect of periconceptional multivitamin-mineral supplementation on vertigo, nausea and vomiting in the first trimester of pregnancy. Arch Gynecol Obstet 1992;251:181-5.
46. Koren G, Maltepe C. Preventing recurrence of severe morning sickness. Can Fam Physician 2006;52:1545-6.
47. Koren G, Maltepe C. Pre-emptive therapy for severe nausea and vomiting of pregnancy and hyperemesis gravidarum. J Obstet Gynaecol 2004;24:530-3.
48. Semmens JP. Hyperemesis gravidarum; evaluation and treatment. Obstet Gynecol 1957;9:586-94.
49. Crystal SR, Bowen DJ, Bernstein IL. Morning sickness and salt intake, food cravings, and food aversions. Physiol Behav 1999;67:181-7.
50. Evans AT, Samuels SN, Marshall C, Bertolucci LE. Suppression of pregnancy-induced nausea and vomiting with sensory afferent stimulation. J Reprod Med 1993;38:603-6.
51. Keating A, Chez RA. Ginger syrup as an antiemetic in early pregnancy. Altern Ther Health Medicine 2002;8:89-91.
52. Rosen T, de Veciana M, Miller HS, Stewart L, Rebarber A, Slotnick RN. A randomized controlled trial of nerve stimulation for relief of nausea and vomiting in pregnancy. Obstet Gynecol 2003; 102:129-35.
53. Yost NP, McIntire DD, Wians FH, Jr., Ramin SM, Balko JA, Leveno KJ. A randomized, placebo-controlled trial of corticosteroids for hyperemesis due to pregnancy. Obstet Gynecol 2003; 102:1250-4.