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Non-Medicaid enhanced prenatal care programs for adolescents

Health Care: Maternal and Infant Health
Benefit-cost methods last updated December 2019.  Literature review updated December 2016.
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Non-Medicaid enhanced prenatal care programs for pregnant adolescents include intensive case management, group classes, or both, provided by either a paraprofessional or team of health service providers. Adolescent women are eligible for these programs if they are 18 or under during their pregnancy. Participants typically receive services for four months during the prenatal period, with an average of 12 one-hour sessions. All women in treatment and comparison groups receive clinical prenatal care (treatment as usual).
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2018). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $657 Benefits minus costs $2,604
Participants $264 Benefit to cost ratio $5.90
Others $0 Chance the program will produce
Indirect $2,214 benefits greater than the costs 73 %
Total benefits $3,135
Net program cost ($531)
Benefits minus cost $2,604
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Health care associated with preterm births $59 $0 $0 $30 $89
Subtotals $59 $0 $0 $30 $89
From secondary participant
Infant mortality $112 $264 $0 $2,207 $2,584
Health care associated with preterm births $486 $0 $0 $243 $729
Subtotals $598 $264 $0 $2,450 $3,312
Adjustment for deadweight cost of program $0 $0 $0 ($266) ($266)
Totals $657 $264 $0 $2,214 $3,135
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,888 2014 Present value of net program costs (in 2018 dollars) ($531)
Comparison costs $1,383 2014 Cost range (+ or -) 15 %
Per-participant program cost estimates are based on estimated costs for included studies. For each study, we estimate provider hours, apply the mean hourly wage estimate for Washington State reported by the Bureau of Labor Statistics (September 2016), and increase wages by a factor of 1.441 to account for the cost of employee benefits. Studies averaged 12 provider hours, and providers varied (paraprofessional, social workers, nurse, or multiple providers). Program participants also receive treatment as usual, so we include the average cost of prenatal care in Washington in the total program cost. The comparison costs include the cost of treatment as usual, per participant. The costs of treatment as usual are the average costs of usual prenatal care in Washington State (Washington State Department of Health, September 2016).
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

***We report this outcome twice: once for mothers (designated as the primary participant) and once for infants (designated as the secondary participant). We do this because the outcome is associated with costs and benefits for both mothers and infants, and the amount of the cost or benefit is different for mothers than it is for infants.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes(ES) and standard errors(SE) used in the benefit - cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Low birthweight births (< 2500g)*** 16 Primary 4 2556 -0.106 0.105 16 0.000 0.000 17 -0.155 0.185
Preterm birth (< 37 weeks)*** 16 Primary 2 2004 -0.181 0.140 16 0.000 0.000 17 -0.216 0.041
Very low birthweight birth (< 1500g)*** 16 Primary 1 744 -0.058 0.069 16 0.000 0.000 17 -0.162 0.019
Infant mortality 1 Secondary 1 744 -0.037 0.069 1 0.000 0.000 2 -0.102 0.141
Low birthweight births (< 2500g)*** 1 Secondary 4 2556 -0.106 0.105 1 0.000 0.000 2 -0.155 0.185
Preterm birth (< 37 weeks)*** 1 Secondary 2 2004 -0.181 0.140 1 0.000 0.000 2 -0.216 0.041
Very low birthweight birth (< 1500g)*** 1 Secondary 1 744 -0.058 0.069 1 0.000 0.000 2 -0.162 0.019

Citations Used in the Meta-Analysis

Hardy, J.B., King, T.M., & Repke, J.T. (1987). The Johns Hopkins Adolescent Pregnancy Program: an evaluation. Obstetrics and Gynecology, 69(3), 300-6.

Korenbrot, C.C., Showstack, J., Loomis, A., & Brindis, C. (1989). Birth weight outcomes in a teenage pregnancy case management project. Journal of Adolescent Health Care, 10(2), 97-104.

Sangalang, B.B., Barth, R.P., & Painter, J.S. (2006). First birth outcomes and timing of second births: A statewide case management program for adolescent mothers. Health & Social Work, 31(1), 54-63.

Covington, D.L., Peoples-Sheps, M.D., Buescher, P.A., Bennett, T.A., & Paul, M.V. (1998). An Evaluation of an Adolescent Prenatal Education Program. American Journal of Health Behavior, 22(5), 323-33.