P171. Health care cost analysis for deliveries according to the maternal age classes in an university hospital setting: a five-years retrospective cohort study

STEFANIA TRIUNFO (IT), MASSIMO VOLPE (IT), TATIANA ANTONIELLI (IT), STEFANO FRUCI (IT), ANTONIO LEMBO (IT), FRANCESCA PETRILLO (IT), ANTONIO LANZONE (IT)

[TRIUNFO] Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy., [VOLPE] Clincal Directorate, Fondazione Policlinico Universitario ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy., [ANTONIELLI] Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy., [FRUCI] Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy., [LEMBO] Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy., [PETRILLO] Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy., [LANZONE] Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario ‘A. Gemelli’

Context: In last decades, demographic changes in the family planning have been observed in developped countries, characterized by delayng in childbearing in women more involved in the society. Objective: To perform the health care cost analysis for clinical assistence at delivery, segregated by maternal age-classes in an university hospital setting Methods: A descriptive cost analysis for assistance at the overall births in the study period was assessed based on hospital discharge report from local health care system, and calculated by using the ‘diagnosis-related group’ (DRG) approach. Patients: Women delivering in a 5-year period (2012-2016). Interventions: Assistance in deliveries, according to local and international guidelines. Main outcomes measures: Categorical costs according to maternal age classes (<10, 20-24, 25-29, 30-34, 35-39, 40-45, ≥45 years). Results: A total of 18,093 were admitted to the university hospital for birth assistance in the study period, with an overall economic cost due to clinical assistence at delivery of € 42.663.481. A global rate of 59.6% of vaginal deliveries (VD) and 40.4% of cesarean section (CS) was calculated. Among of all maternal age classes, women attributable to classes 30-34 and 35-39 years reched a rate of 62.8%, while values of 24.2% and 13% were observed for those under 30 and above 40 years of age, respectively. A signficant increasing trend in terms of overall maternal stay duration was found across all age-groups (from 4.7 to 5.4 days, p < 0.05), as well as non-specific delivery costs (from € 2.222,49 to €2.401,29, p < 0.05). Uncomplicated VD decreased across the groups, until to helve between two extreme maternal age-groups (38.8% vs. 18.6%, p < 0.05), while a 3-fold risk of CS complications was calculated in women above 45 years-old in comparison with those under 20 years of age (4.2 vs. 13.9, p < 0.05), although not significanttly different in the cost analysis between two extreme age-groups. Conclusions: Progressive increases in maternal age at delivery are associated with higher healthcare costs, driven largely by additional complications rates, irrespective to the delivery mode.