|Equation||(# pregnant women) x (% mothers getting assistance solely because of the program) x (Q1: % avoided low-birthweight or preterm births due to the intervention) x (# QALY increase) x ($ QALY)|
|Explanation||Enhanced prenatal care programs delivered through Medicaid provide non-clinical services that support maternal wellness and infant health during the prenatal period, such as care coordination, health education, risk assessment, psychosocial support, or nutritional counseling. These programs are delivered in a primary healthcare setting and provided by either a nurse or a social worker. Women are eligible for these programs during pregnancy, with some benefits continuing through the first twelve months postpartum. Participants typically receive program benefits for three to sixteen months, including both prenatal and postpartum services.|
Number of pregnant women: Reported by program.
Percentage of women getting assistance solely because of the program: Estimated by Constellation Fund staff.
Q1: Percentage of avoided preterm births due to the intervention: [0.05].
Estimated by Constellation’s staff using the following formula:
In this formula, ES is the effect size from meta-analysis of prenatal care programs on low-weight births [-0.087] (WSIPP, 2017). The base percentage is [7%-20%], which is based on the incidence rate ranging from 7% to 20% from several studies. The rate of low birth weight is about 15% across all education levels for black mothers, rising to 20% in poor neighborhoods, and is about 7% among all Latina mothers (Collins, Wambach, David & Rankin, 2009; Elo et al., 2009; Hamilton, Martin & Ventura, 2010).
QALY increase: [2.8]. This is the estimate for the value of avoidance of low birth weight based on the work of Johnson & Shoeni (2007), which finds that children born at less than 5.5 pounds are more likely to experience poor health in childhood and adulthood even after accounting for many covariates. Technical note: QALY impact estimated by Constellation staff using results from Johnson & Shoeni (2007) as follows: the authors estimate the impact of LBW on health quality index (100pts) to be 3.77. We assume a life expectancy of 75 years, resulting in an impact of 2.8 QALYs [3.77 x 75/100].
$ value per QALY: [$50,000]
Benefits are then discounted to present value based on the average age of participation to life expectancy.
|References||Arima, Y., Guthrie, B.L., Rhew, I.C., & De Roos, A.J. (2009). The impact of the First Steps prenatal care program on birth outcomes among women receiving Medicaid in Washington State. Health Policy (Amsterdam, Netherlands), 92(1), 49-54.|
Buescher, P.A., Roth, M.S., Williams, D., & Goforth, C.M. (1991). An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina. American Journal of Public Health, 81(12), 1625-9.
Collins, J. W., Jr., Wambach, J., David, R. J. & Rankin, K. M. (2009). Women’s lifelong exposure to neighborhood poverty and low birth weight: A population study. Maternal and Child Health Journal, 13(3), 326–333.
Elo, I., Culhane, J., Kohler, I., O’Campo, P., Burke, J., Messer, L., Kaufman, J., Laraia, B., Eyster, J., and Holzman, C. (2009). Neighbourhood deprivation and small-for-gestational term births in the United States. Paediatric and Perinatal Epidemiology, 23(1), 87–96.
Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2010). Births: preliminary data for 2009. National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics. 59(3), 1–19. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25073731
Hillemeier, M.M., et al. (2015). Effects of maternity care coordination on pregnancy outcomes: propensity-weighted analyses. Maternal and Child Health Journal, 19(1), 121-7.
Johnson, R. C., & Schoeni, R. F. (2011)., and The influence of early life events on human capital, health status, and labor market outcomes over the life course. The B.E. Journal of Economic Analysis & Policy, 11(3).
Korenbrot, C., & Patterson, E. (1995). Evaluation of California’s Statewide Implementation of Enhanced Perinatal Services as Medicaid Benefits. Public Health Reports, 110(2), 125-133. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1382091/
Washington State Institute of Public Policy -WSIPP (2017). Retrieved from http://www.wsipp.wa.gov/BenefitCost/Program/680