(290) Use and out-of-pocket costs of antenatal fetal surveillance for patients with chronic conditions

To measure variation in use and out-of-pocket costs for antenatal fetal surveillance (AFS) among commercially insured patients with chronic hypertension or pre-gestational diabetes.

Study Design:
This was a cross-sectional analysis of pregnancies of at least 20-weeks’ gestation between 2017-2022. We used administrative enrollment and health insurance claims data from the Health Care Cost Institute, which includes commercially insured pregnancies nationwide. Our sample included patients with chronic hypertension or pre-gestational diabetes. Our outcomes were the number of days with AFS testing during pregnancy, the out-of-pocket costs for those tests, and those costs as a proportion of all out-of-pocket costs during pregnancy. We use linear regression models to compare variation in these outcomes by health plan type, patient factors (age, clinical characteristics), and geographic factors (rurality, maternity care access, and area-level income and race distributions).

Results:

Our sample included over 150,000 pregnancies with chronic hypertension or pre-gestational diabetes. On average, patients with chronic hypertension received 5.1 AFS tests and those with pre-gestational diabetes received 6.5. There was significant variation in the number of AFS received, with 15.9% of patients with chronic hypertension and 12.3% of those with pre-gestational diabetes receiving no AFS tests during pregnancy. Receiving no AFS was most common for patients in areas that were rural, low-income, or had a higher concentration of Black individuals. One-quarter of patients with chronic conditions faced out-of-pocket costs for AFS of $264 or more, or $301 or more for a quarter of patients with pre-gestational diabetes. Patients in POS or PPO plans, in rural areas, and in areas with a higher concentration of white people had higher costs.

Conclusion:

AFS is the primary tool for stillbirth prevention, yet we found wide variation in AFS use and costs in this commercially-insured population of high-risk pregnancies – including many patients who receive no AFS.