(171) Impact of emergency room abortion bans on pregnancies with previable preeclampsia: a cost-effectiveness analysis.

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

David M. Monroe, MD, MPH

Oregon Health & Science University
Portland, Oregon, United States

Coauthor(s)

Ava D. Mandelbaum, BA (she/her/hers)

Oregon Health & Science University
Portland, OR, United States
Aaron B. Caughey, MD, PhD

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

Objective: In August 2022, the federal government sued the state of Idaho, arguing that the federal Emergency Medical Treatment and Labor Act (EMTALA) required providers in the state to provide abortions in certain emergency situations. The suit cited severe preeclampsia as a condition that would require abortion as definitive treatment, particularly in the previable period. This cost-effectiveness model estimated the maternal health outcomes and costs associated with an inability to provide emergency abortion care for previable preeclampsia across the United States.

Study Design: A decision-analytic model was built using TreeAge software to evaluate a total ban on emergency abortion in a theoretical cohort of 5,428 women based on the incidence of previable preeclampsia and birth data from the 23 states with bans. Probabilities, utilities and costs were derived from the literature. National data were 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 ICU admission, cases of HELLP syndrome or eclampsia, maternal death, NICU admission, and neonatal neurodevelopmental delay.

Results: Emergency abortion bans limiting care for previable severe preeclampsia resulted in 549 additional maternal and neonatal ICU admissions, 1,976 cases of HELLP syndrome, and 152 cases of eclampsia. The ban resulted in 1,476 individuals traveling out-of-state for termination. A policy restricting abortion was associated with higher costs ($374,350,596) and decreased quality of life (2,859 QALYs) annually.

Conclusion: Abortion bans that restrict emergency abortion care to treat previable severe preeclampsia result in increased maternal complications and costs and decreased quality of life. Policies addressing abortion access should consider these health and cost impacts for both individuals and society.