What does it cost?

February 16, 2017
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by Lindsey Wimmer, MSN, CPNP, CPLC

Whenever a new idea is introduced into medicine, one of the first questions is – “How much will it cost?”

This is frustrating to me because it gives the impression we are more worried about money than the health, life, and well-being of human beings.  However, I also understand the need to be good stewards of our resources.

Where is that line?

Most health professionals are similarly frustrated because they are caring people, but they must function within the business of health care.  They have to balance these two significant forces that can’t be compared fairly.

cost benefit riskIn an attempt to make this balance easier, we have concepts such as “cost/benefit ratio” and “number to treat”.  These objective measures help us identify how much would be spent in order to receive a benefit.  The number to treat figures will tell us how many people would need to receive the given treatment in order for one person to benefit.

Looking at these numbers makes us realize that healthcare is expensive.  Very expensive.

But – so is poor health and death.

Stillbirth prevention efforts are subject to the same cost considerations.

But we know there is a cost to stillbirth, too.  Just some of these potential costs:

  • Tangible costs related to disposal of the body and postmortem testing.
  • Mental health costs in counseling or therapy
  • Lost productivity at work and in the community.
  • Medication costs to address mental health concerns related to the loss.
  • Cost of increased testing/monitoring in subsequent pregnancies.
  • Altered sense of joy or hope
  • Lower sense of self-worth or increased sense of guilt
  • Physical and mental health impact related to grief, anxiety, stress
  • Loss of relationships
  • Loss of fertility
  • Altered sense of parenthood
  • Loss of dreams and plans for the future
  • Loss of innocence

It is not a guarantee that every parent or family will experience all of the potential costs.  And the degree to which the costs are felt certainly vary, too.

But most of these costs are not considered in cost/benefit ratios.  And even if they were, every family would have a different perspective on how much they would be willing to spend financially to prevent these potential outcomes.

In Number to Treat conversations, it may seem very simple until you are the one that might be saved from these potential costs by spending more money on a treatment or intervention.  It’s a reverse lottery that most people don’t realize they are playing.

Dr. Alexander Heazell and colleagues address many of these costs in their paper “Stillbirths: economic and psychosocial consequences”.   More recently, Newsweek addressed the economic costs of losing a child.

These papers and more are desperately needed because the lack of awareness around perinatal loss further complicates these discussions.  For people who have never experienced the death of a baby and only know easy, uncomplicated, healthy pregnancies and deliveries, spending additional money for the same outcome does seem unnecessary and wasteful.  For those who have experienced a loss, financial costs seem trivial if they could have prevented their baby’s death.

How do you measure heartache?

I don’t have an easy answer, but I do think we need to honor these babies and parents by understanding and respecting the costs they will endure.  Often, they will be forced to absorb these costs because of decisions made using mathematical and economic analyses.

Not every good decision makes sense on a financial ledger.

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