Icon Legend

This session is not in your schedule.

This session is in your schedule. Click again to remove it.

Presentation Icons

Additional registration fee required

Faculty have requested this content not be shared on social media

CME Credit Offered

Poster Icons

Foundation Awardee

No Social Media

Back

Q&A

Healthcare Policy/Economics

Poster Session 3

(709) Impact of abortion bans on pregnancies with severe life-limiting fetal anomalies: a cost-effective analysis.

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

David Monroe, MD, MPH

Oregon Health & Science University
Portland, OR, United States

Coauthor(s)

UD

Uma Doshi, BS, MCR (she/her/hers)

Medical Student
Oregon Health & Science University
Portland, OR, United States
KB

Kimberley Bullard, MD, MPH

University of Tennessee College of Medicine Chattanooga
Chattanooga, TN, United States
Aaron B. Caughey, MD, PhD

Professor and Chair
Oregon Health & Science University
Portland, OR, United States

Objective: Since the US Supreme Court decision in Dobbs v. Jackson Women’s Health to overturn a constitutional right to abortion in June 2022, 24 states have enacted laws prohibiting termination of pregnancy before most fetal anomalies are diagnosed. No exceptions are made for trisomy 13, trisomy 18, or anencephaly, which are severe life-limiting conditions with significant morbidity for survivors and their mothers. In this cost-effectiveness model, we estimated the difference in cost and maternal health outcomes associated with a termination ban for severe life-limiting fetal anomalies.

Study Design: A decision-analytic model was built using TreeAge software to compare a total ban on termination in a theoretical cohort of 1038 women constructed from the annual incidence of trisomy 13, trisomy 18, or anencephaly (5.76/10000) and birth data from the 24 states with bans. All of these women were assumed to desire termination. Probabilities, utilities and costs were derived from the literature. National data was used to estimate the number of women who would travel out of state to obtain an abortion (27.2%). The threshold for cost-effectiveness was set at $100,000 per quality adjusted life year (QALY). Clinical outcomes included maternal death, stillbirth, birth of neonates with severe disease, severe preeclampsia, blood transfusion for hemorrhage, and infections.

Results: Among the cohort, there would be 734 more live births affected by a severe life-limiting anomaly with an abortion ban in place. A policy restricting termination is associated with higher costs ($76,257,272) and decreased quality of life (4065 QALYs) annually. Two hundred and eighty-two women would travel out of state to obtain abortions.

Conclusion: Termination bans without exceptions for severe life-limiting fetal anomalies significantly restrict access to care for affected women and are associated with increased costs and worse health outcomes. Policies addressing abortion access should consider these health and cost impacts for both individuals and society.