(1081) The Impact of Removing Abortion Access to Patients with Chronic Kidney Disease: A Cost-Effectiveness Analysis

In the 2022 ruling in Dobbs v Jackson Women’s Health, the United States Supreme Court returned abortion access back to where it was in 1973, constitutionally unprotected. This has had wide-reaching impacts on people capable of becoming pregnant, potentiates deadly outcomes, and inflicts costs on our health system. The current study focuses on how abortion access affects people who are pregnant, have chronic kidney disease (CKD), and desire an abortion. With both maternal and fetal/neonatal health in mind, we will examine the outcomes and costs associated with providing or refusing in-state access to abortions for this population.


Study Design:

A decision-analytic model was built to compare the costs associated with providing abortions in-state compared to the costs associated with a statewide abortion ban. The model considers documented outcomes of pregnancy with CKD (preeclampsia, preterm birth, maternal mortality) and considers the progression of kidney disease. The model also considers the likelihood and costs associated with traveling to another state for an abortion.


Results:

In a cohort of 31,243 pregnant people with CKD, providing abortions resulted in 1,130 fewer cases of preeclampsia, 2,264 fewer preterm births, 6,411 fewer cases of chronic kidney disease stage progression, 731 fewer cases of ESRD requiring dialysis, and 139 fewer maternal deaths. Due to the increased incidence of perinatal complications and a progression of maternal chronic kidney disease, an absence of in-state abortion access was associated with an increased cost of $470,769,524 and a decrease of 14,997 QUALYs compared to those in states with abortion access.


Conclusion:

Providing in-state abortion access to pregnant people with chronic kidney disease is a cost-effective strategy. Due to the direct decrease in preeclampsia, preterm birth, maternal mortality, and progression of kidney disease, allowing these patients to terminate their pregnancies saves a considerable amount of money. Jurisdictions that have restricted abortion access should consider implementing increased access to lower both medical and societal costs.