Table Of Contents«*v.C£$.^
Economics of Reproductive and
An
Infant Health: Annotated
From
Bibliography 1980 to 1993
December 1995
I U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Centers for Disease Control and Prevention
CENTERASNFDORPRDEIVSEENATSIEOCNONTROL National Center for Chronic Disease Prevention and Health Promotion
Division ofReproductive Health
. .
This publication was developed and produced by the National Center for Chronic Disease Prevention
and Health Promotion of the Centers for Disease Control and Prevention.
National Center for Chronic Disease
Prevention and Health Promotion James S. Marks, M.D., M.P.H.
.
Director
Virginia S. Bales, M.P.H.
Deputy Director
Technical Information and Editorial Services Branch Christine S. Fralish, M.L.I.S.
Chief
Gail A. Cruse, M.L.I.S.
Technical Information Specialist
Division of Reproductive Health E. Thomas Starcher, III
Acting Director
Lynne S. Wilcox, M.D., M.P.H.
Deputy Chief, Program Services and Development Branch
Suggested Citation
Centers for Disease Control and Prevention. Economics ofReproductive and Infant Health:
An Annotated Bibliography From 1980 to 1993. Atlanta, Georgia: U.S. Department of
Health and Human Services, Public Health Service, Centers for Disease Control and
Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1995.
This publication was prepared by Aspen Systems Corporation under Contract No. 200-92-0526 for
the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease
Control and Prevention, Public Health Service, U.S. Department of Health and Human Services.
Contents should not be construed as the official policy of the National Center for Chronic Disease
Prevention and Health Promotion or any agency of the federal government.
f^tiOfcp^&l
Economics of Reproductive and
An
Infant Health: Annotated
From
Bibliography 1980 to 1993
December 1995
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division ofReproductive Health
Economics of Reproductive and Infant Health:
An Annotated Bibliography From 1980 to 1993
December 1995
Table of Contents
Preface
iii
How to Use This Publication v
1. Infant and Child Health
Preterm Birth and Neonatal Care 1
General Infant and Child Health 25
References 41
2. Birth Defects, Mental Retardation, and Chronic Conditions
Prenatal Screening for Infant Conditions 47
Infant Screening 61
Mental Retardation, Down's Syndrome, and Developmental Disability 73
Genetic Disorders and Chronic Conditions 83
References 93
3. Maternal Health
Services Delivery 99
Screening for Maternal Infections and Conditions 109
Alcohol, Tobacco, and Drug Use 129
Adolescent Pregnancy 135
Cesarean Section 143
Preterm Labor, Placenta Previa, and Cerclage 153
Economics and Prenatal Care 161
References 171
4. Family Planning and Women's Reproductive Health 179
References 193
5. Nutrition 199
References 205
6. International Health 207
References 219
7. Methods 223
References 249
INDEXES
Title Index 257
Author Index 271
Subject Index 287
Preface
For
the foreseeable future, public health professionals can expect fiscal concerns to heavily
influence health and prevention policies. Without a thorough understanding of the costs and
the impact of health services, we run the risk of losing resources to provide these services.
No matter how compelling the arguments of need, equity, or compassion are, policymakers will need
evidence of economic efficiency to accompany information on health improvement. Without such
cost-related data, those of us who advocate for the health and well-being of women and children will
be diminished in our effectiveness.
To address this need, the Division of Reproductive Health, National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and Prevention, has assembled
relevant literature on economic issues in reproductive health. This annotated bibliography covers
published reports from 1980 to 1993 and includes 266 abstracted articles and 238 additional
references. It addresses a wide range of concerns in women's and children's health and presents
studies on cost-benefit, cost-effectiveness, cost utility, and other economic analyses. Along with
studies of specific conditions, it includes articles related to methodology in economic analysis that will
aid us all in becoming more informed users of economic reports. Although our literature search may
not have identified all relevant material, we believe that this bibliography provides useful information
on the state of knowledge in this field as it relates to reproductive health.
A review of the articles presented in this bibliography indicates that much information is already
available on the economics of women's and children's health. For example, some topics, such as
neonatal intensive care and birth defects screening services, have received extensive attention and
analyses. But many gaps still exist. Pediatric passive smoke exposure, for example, is only
beginning to be examined from an economic perspective. We hope that this bibliography will aid in
highlighting both the depth and the gaps in our current knowledge and will prepare us to make use of
what is known and to investigate what remains to be learned.
Readers are cautioned to examine these studies with care because the methods of analysis are not yet
standardized—papers with different findings may represent quite different approaches to the issue
under investigation. The challenges facing researchers who study the economic health issues
concerning women and children include defining the measurements of costs, identifying the services
whose costs will be assessed, and defining the duration over which outcomes will be measured.
Variations in definitions for each of these variables can produce different conclusions.
As public health workers have always known, we must also recognize that decisions regarding the
best use of public resources are not based solely on economic concerns. The most sophisticated
techniques of cost measurement cannot describe all the benefits and disadvantages of a specific health
program. Furthermore, such decisions must take into account the public's will to act on a health
problem even if money is not saved or an intervention is costly. Economic analyses may usefully
inform these decisions but are unlikely to provide the complete answer to the question, "Is this health
service appropriate?" Even if some highly regarded preventive interventions are found costly for a
given impact, such analysis can point researchers toward finding more efficient and less costly
approaches.
in
We hope public health professionals in both practice and academia, clinicians, insurers, and others
concerned with the health of women and children will find this a useful compilation. As advocates,
we need to give decision makers the factual basis upon which to decide with confidence that fiscal
prudence, along with altruistic concern, favors a woman- and child-oriented approach to health care.
IV
How
to Use This Publication
Arrangement ofItems
Items in this publication are arranged in seven sections: (1) Infant and Child Health; (2) Birth
Defects, Mental Retardation, and Chronic Conditions; (3) Maternal Health; (4) Family Planning and
Women's Reproductive Health; (5) Nutrition; (6) International Health; and (7) Methods. The sections
are divided into several parts. Items in each part are listed in alphabetical order by author. The
items are numbered sequentially, beginning with 001.
Space considerations did not allow for abstracting of every item we chose to include in this
publication. The nonabstracted items are contained in the Reference Lists at the end of their relevant
section and are denoted with an "R" before their sequential number.
Indexes
This publication contains three indexes. The Title Index lists document titles. The Author Index lists
personal and corporate authors. The Subject Index lists selected key words describing the content of
publications. If you know the title of a publication, use the Title Index. If you are looking for a
publication produced by a particular person or agency, use the Author Index. If you want to identify
items in a specific subject area, such as smoking education programs, use the Subject Index.
Data Elements
A citation and abstract are listed for each item in this publication. Data elements include the item
number, title, form, author or corporate author, source, and abstract.
Sample Description:
Item Number 109
Title Costs and Benefits of Screening for PKU in Wisconsin.
Form Journal article.
Author Barden, H.S.; Kessel, R.; Schuett, V.E.
Source Social Biology 31(1-2):1-17, Spring-Summer 1984.
.
Abstract Researchers conducted a comprehensive cost-benefit analysis ofa screening program to detect
newborns with phenylketonuria (PKU) in Wisconsin. Classic PKU is a genetic disorder which, if
undetected and untreated during the first few weeks of life, generally results in mental retardation and
a variety ofother abnormal conditions. Researchers compared monetary costs ofthe detection and
treatment program with the projected benefits (avoided costs) that result from the prevention ofthe
mental retardation associated with the disorder. Investigators determined future costs and benefits
using a 4 percent, 7 percent, and 10 percent rate of discount to achieve comparability between the
present and future costs. The estimated costs ofthe State Laboratory of Hygiene for PKU testing for 1
year were $104,740 for 78,050 samples. Actual costs ofcollecting a blood specimen for testing were
estimated at $4.60 per collection. Treatment costs for PKU for a 20-year period (discounted at 7
percent) were estimated at $40,830. Net benefits (benefits minus costs) for detecting and treating one
person with PKU were $208,000 ($292,000 minus $84,000) using the 7 percent rate ofdiscount. Net
benefits for detecting four persons with PKU per year in Wisconsin totaled $832,000, a large rate of
return on a relatively small investment. 10 tables, 42 references.
Obtaining Additional Information
Questions about this publication may be directed to:
Division of Reproductive Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
4770 Buford Hwy, NE, Mailstop K-22
Attn: Lynne S. Wilcox, MD, MPH
Atlanta, Georgia 30341-3724
(770) 488-5227
VI
