The cost of maternity and neonatal care in Aotearoa New Zealand: A cost analysis by plurality and gestation using a population-based cohort.

Background: Maternity services in New Zealand are largely delivered by autonomously practising community midwives. This model of care is unique and may result in differences in the distribution of maternity healthcare utilisation and costs compared to other countries. New Zealand-specific cost data are needed to inform economic analyses, local policy and healthcare resource planning.

Aims: To provide estimates of the average total cost of maternity and neonatal healthcare for New Zealand women and infants, including cost impacts of multiple and preterm births.

Materials And Methods: A whole-of-population linked dataset, including 262 687 pregnancies resulting in a live birth (from 1 January 2016 to 30 June 2020), was created by combining several sources of healthcare data to calculate an average per-pregnancy cost of healthcare, taking a public health system perspective, during antenatal, intrapartum, and postnatal periods to one year after birth.

Results: The mean cost of public healthcare was NZ$19 795 for both maternal and infant care to one year post-birth. The bulk of this cost was incurred during pregnancy and birth. Mean total cost to one year was NZ$69 895 for twin and NZ$201 448 for higher order multiple compared to singleton pregnancies at NZ$19 098. Mean total healthcare cost decreased as gestation increased.

Conclusions: Most of the costs associated with pregnancy and childbirth were incurred during the birth and in the early neonatal period. Costs were disproportionately higher for multiple and preterm births. These cost data can usefully inform policy and assist healthcare decision-making around reproductive and neonatal technologies.