Background
Several states require that abortions be provided in ambulatory surgery centers. Supporters
of such laws argue that they make abortions safer, yet previous studies have found
no differences in abortion-related morbidities or adverse events for abortions performed
in ambulatory surgery centers versus office-based settings. However, little is known
about how costs of abortions provided in ambulatory surgery centers differ from those
provided in office-based settings.
Objective
To compare healthcare expenditures for abortions performed in ambulatory surgery centers
versus office-based settings using a large national private insurance claims database.
Materials and Methods
A retrospective cohort study compared expenditures for abortions performed in ambulatory
surgery centers versus office-based settings. Data on women who had abortions in an
ambulatory surgery center or office-based setting between January 1, 2011, and December
31, 2014 were obtained from the MarketScan Commercial Claims and Encounters database.
The sample was limited to women who were continuously enrolled in their insurance
plans for at least 1 year before and at least 6 weeks after the abortion. Healthcare
expenditures were assessed separately for the index abortion and the 6-week period
after the abortion. Costs were measured from the perspective of the healthcare system
and included all payments to the provider, including insurance company payments and
any patient out-of-pocket payments.
Results
Overall, 49,287 beneficiaries who had 50,311 abortions met inclusion criteria. Of
the included abortions, 47% were first-trimester aspiration, 27% first-trimester medication,
and 26% second-trimester or later abortions. Most abortions (89%) were provided in
office-based settings, with 11% provided in ambulatory surgery centers. Unadjusted
mean index abortion costs were higher in ambulatory surgery centers than in office-based
settings ($1704 versus $810; P < .001). After adjusting for patient clinical and demographic characteristics, costs
of index abortions were $772 higher (95% confidence interval, $746–$797), total follow-up
costs for abortions that had any follow-up care were $1099 higher (95% confidence
interval, $1004–$1,195), and total follow-up costs for abortions that had an abortion-related
morbidity or adverse event were not significantly different in ambulatory surgery
centers compared to office-based settings. There were also no significant differences
in the likelihood of having any follow-up care or abortion-related event follow-up
care.
Conclusion
Abortions performed at ambulatory surgery centers are significantly more costly than
those performed in office-based settings, with no difference in the likelihood of
receiving follow-up care. Laws requiring that abortions be provided in ambulatory
surgery centers may only result in increased costs for abortions, with no effect on
abortion safety.
Key words
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Article info
Publication history
Published online: October 17, 2019
Accepted:
October 12,
2019
Received in revised form:
September 6,
2019
Received:
May 5,
2019
Footnotes
The authors report no conflict of interest.
This study was supported by a grant from the Society of Family Planning, SFPRF10-10.
Cite this article as: Leslie DL, Liu G, Jones BS, et al. Healthcare costs for abortions performed in ambulatory surgery centers versus office-based settings. Am J Obstet Gynecol 2020;222:348.e1-9.
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