(1201) The Impact of Denying Abortion Access to Patients with Heart Failure: a cost-effectiveness analysis

In June 2022, the Dobbs v. Jackson Women’s Health Supreme Court decision eliminated constitutional protections for abortion access. This ruling has far-reaching impacts on long-term morbidity, mortality, and health-related expenses for individuals capable of pregnancy. This study investigates the influence of abortion access on outcomes for pregnant individuals with stage 1 or 2 heart failure (HF) seeking abortion care based on the presence of a statewide abortion ban.


Study Design:

A decision-analytic model was developed to evaluate the outcomes and cost-effectiveness associated with providing in-state abortion services versus those incurred under a statewide abortion ban for individuals with HF seeking an abortion. Clinical outcomes included preeclampsia, preterm birth, pregnancy-related major adverse cardiac events (MACE), disease progression, and mortality. The likelihood and financial burden of traveling out of state for abortion care was considered. The cost-effectiveness threshold was set at $100,000/QALY. Model inputs were derived from the literature.


Results:

In our theoretical cohort of 1,515 pregnant people with HF, access to abortion services led to 348 fewer cases of preeclampsia, 315 fewer preterm births, 218 fewer cases of pregnancy-related MACE, 233 fewer cases of HF stage progression, and 112 fewer deaths annually relative to no access to abortion services (Table 1). In-state abortion access was the dominant strategy, resulting in a $57,229,928 reduction in the costs and an increase in 3,182 QALYs.


Conclusion:

Protecting in-state abortion access for pregnant individuals with HF is a cost-effective strategy, reducing adverse perinatal outcomes, enhancing resource allocation, and improving quality of life. These findings may inform policies to improves individual and societal outcomes for this vulnerable population in the context of restrictive abortion laws.