背景:已证明妊娠期间的驱逐与不良分娩结局相关。专注于支付怀孕期间租金费用的安全网计划可能有助于预防不良并发症。
目的:本研究旨在评估一项涵盖租金费用的计划的成本效益,以防止怀孕期间被驱逐。
方法:设计了使用TreeAge软件的成本效益模型来评估成本,有效性,与怀孕期间没有驱逐相比,与驱逐相关的增量成本效益比。从社会角度来看,驱逐成本与不驱逐组的年度住房成本进行了比较,这是根据2021年全国人口普查数据得出的美国合同租金中位数估算的。出生结果包括早产,新生儿死亡,和严重的神经发育迟缓。概率和成本来自文献。成本效益阈值设定为$100,000/QALY。我们进行了单变量和多变量敏感性分析,以评估结果的稳健性。
结果:在我们每年30,000名年龄在15至44岁的孕妇面临驱逐的理论队列中,怀孕期间不驱逐策略与1427例早产减少有关,新生儿死亡人数减少47人,与驱逐相比,神经发育迟缓的病例减少了44例。按美国租金成本的中位数计算,不逐出策略与质量调整后的寿命年增加和成本降低相关.因此,不驱逐策略是主导策略。在改变住房成本的单变量敏感性分析中,没有驱逐仍然是具有成本效益的策略,当租金低于每月1016美元时,可以节省成本。
结论:不驱逐策略具有成本效益,可减少早产病例,新生儿死亡,神经发育迟缓.当租金低于每月1016美元的中位数时,不驱逐是节省成本的策略。这些发现表明,支持社会方案实施的政策,为有被驱逐风险的孕妇提供租金覆盖,有可能在减少围产期结局的成本和差异方面非常有益。
Eviction during pregnancy has been shown to be associated with adverse birth outcomes. A safety net program focused on covering the costs of rent during pregnancy may aid in preventing adverse complications.
This study aimed to evaluate the cost-effectiveness of a program covering the cost of rent to prevent eviction during pregnancy.
A cost-effectiveness model using TreeAge software was designed to evaluate the cost, effectiveness, and incremental cost-effectiveness ratio associated with eviction compared to no
eviction during pregnancy. The cost of eviction from a societal perspective was compared to the annual cost of housing in the no eviction group, which was estimated by the median contract rent in the United States from 2021 national census data. Birth outcomes included preterm birth, neonatal death, and major neurodevelopmental delay. Probabilities and costs were derived from the literature. The cost-effectiveness threshold was set at $100,000/QALY. We performed univariable and multivariable sensitivity analyses to assess the robustness of the results.
In our theoretical cohort of 30,000 pregnant individuals aged 15 to 44 years facing eviction annually, the no eviction during pregnancy strategy was associated with 1427 fewer preterm births, 47 fewer neonatal deaths, and 44 fewer cases of neurodevelopmental delay compared to
eviction. At the median cost of rent in the United States, the no eviction strategy was associated with increased quality-adjusted life-years and decreased costs. Therefore, the no
eviction strategy was the dominant strategy. In univariate sensitivity analysis varying the cost of housing, no eviction remained the cost-effective strategy and was cost-saving when rent was below $1016 per month.
The no eviction strategy is cost-effective and reduces cases of preterm birth, neonatal death, and neurodevelopmental delay. When rent is below the median of $1016 per month, no
eviction is the cost-saving strategy. These findings suggest that policies supporting social programmatic implementation for rent coverage for pregnant people at risk of eviction have the potential to be highly beneficial in reducing costs and disparities in perinatal outcomes.