Impact of abortion bans on pregnancies with severe life-limiting foetal anomalies in the United States: a cost-effectiveness analysis.

Abstract

Objective: Since the US Supreme Court decision in Dobbs v. Jackson Women's Health to overturn the constitutional right to abortion in June 2022, 24 states have enacted laws prohibiting termination of pregnancy before most foetal anomalies are diagnosed. Few practical exceptions are made for trisomy 13, trisomy 18, or anencephaly, which are severe life-limiting conditions with significant morbidity for survivors. In this cost-effectiveness model, we estimated the difference in cost and maternal health outcomes associated with a termination ban for severe life-limiting foetal anomalies.

Methods: A decision-analytic model was built using TreeAge software to compare a total ban on termination in a theoretical cohort of 868 women desiring a termination of pregnancy based on the annual incidence of trisomy 13, trisomy 18, or anencephaly (5.76/10,000) and birth data from the 24 states with bans. Probabilities, utilities and societal costs were derived from the literature. National data were used to estimate the number of women who would travel out-of-state to obtain an abortion (27.2%). The threshold for cost-effectiveness was set at $100,000 per quality-adjusted life year (QALY). Clinical outcomes included maternal death, stillbirth, birth of neonates with severe disease, severe preeclampsia, blood transfusion for haemorrhage, and infections.

Results: With an abortion ban as compared to without, there would be an additional 406 live births affected by a severe life-limiting anomaly, 223 stillbirths, 3 cases of pre-eclampsia, 5 cases of haemorrhage requiring transfusion, and 12 cases of postpartum or postoperative infection. A policy restricting termination is associated with higher costs ($46,223,865) and decreased quality of life (3242 QALYs) annually. Two hundred and thirty-six women would travel out-of-state to obtain abortions.

Conclusion: Termination bans without exceptions for severe life-limiting foetal anomalies significantly restrict access to care for pregnant people and are associated with increased costs and worse health outcomes. Policies addressing abortion access should consider these health and cost impacts for both individuals and society.