Economic implications of poor access to antenatal care in rural and remote Western Australian Aboriginal communities: an individual sampling model of pregnancy

Background: Australian Aboriginal women attend antenatal care less frequently and experience poorer pregnancy outcomes than non-Aboriginal women. Improving access to antenatal care is recognised as a means to improve pregnancy outcomes for mother and baby. Objective: To estimate the costs of inadequate antenatal care and provide baseline measurements and implications for policy that targets improving access to care in rural and remote Western Australian (WA) Aboriginal communities. Methods: An individual sampling model of pregnancy was developed that simulated hypothetical women with pregnancy events and outcomes observed in the WA Aboriginal population. Weekly pregnancy events were modelled via logistic regression according to maternal characteristics, events during pregnancy and current gestation, with adequate and inadequate care (≥4 and \u3c4 antenatal visits) to reflect differences in outcomes reported in the literature. The pregnancy model simulated clinical management including antenatal visits, hospitalisations, and transfers to tertiary care. Results: The mean cost of pregnancy was AUD$8985, with a large difference depending on access to antenatal care (AUD$7635 and AUD$10,216 for adequate and inadequate care respectively). The main difference in costs resulted from neonatal care (AUD$1021 vs AUD$3205 for adequate and inadequate care respectively). In a rural community with 150 births per year, up to AUD$123,082 may be spent to improve access to care at no extra cost to the total current expenditure (AUD$1,347,733). Conclusions: The large difference in pregnancy costs between those receiving adequate and inadequate care demonstrates that additional expenditure on improving access to antenatal care may be cost-effective and should be further investigated