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BACKGROUND: Influenza vaccination is recommended for pregnant women as they are at increased risk for morbidity, mortality, and pre-term delivery. Prior to December 2013, Florida Medicaid did not cover influenza vaccination for pregnant women. In 2012, 108,836 out of 212,954 (51%) of infants were born to Medicaid-receiving pregnant women (MRPW). This investigation evaluates the frequency of influenza diagnosis among pregnant women requiring hospital admission and the payment source for direct medical charges.
METHODS: Florida Agency for Healthcare Administration data for hospital admissions from 2008-2012 were queried for women aged 14-49 diagnosed with influenza (ICD9-CM Code: 487 or 488). Pregnant women were identified using ICD9-CM Codes: 630-679 and V220-222. Payer and charges were abstracted for all pregnant women with diagnosed influenza admitted to hospitals and were stratified by ICU charges and MRPW status.
RESULTS: One hundred eighty-nine pregnant women hospitalized with diagnosed influenza incurred ICU charges and 126 (67%) of these were MRPW. The median annual rate of ICU admissions for diagnosed influenza among pregnant women was 10.8 per 100,000 births (range 5.6 – 51.0), and for Florida MRPW the rate was 12.2 per 100,000 births (range 9.5 – 67.4). Admissions to the ICU with a diagnosis of influenza were 2.15 (95% CI 1.59 – 2.91) times more likely to be among MRPW than non-MRPW. Charges for the 126 MRPW requiring ICU admission totaled $14,173,472, an average charge of $112,488. MRPW incurred charges on average $30,344 higher than non-MRPW ($82,144). A total of 758 hospitalized pregnant women with diagnosed influenza did not require ICU admission. Five hundred and four (66.5%) were MRPW. The median annual rate of admissions not requiring the ICU among pregnant women with diagnosed influenza was 60.6 per 100,000 births (range 16.8 – 156.3). For Florida MRPW the rate was 77.2 per 100,000 births (range 25.4 – 218.5). Individuals hospitalized with diagnosed influenza were 2.13 (95% CI 1.83 – 2.48) times more likely to be MRPW than non-MRPW. Charges for these 504 MRPW totaled $8,284,001, an average of $16,436, about $1500 more than non-MRPW ($14,974).
CONCLUSIONS: Although pregnant women diagnosed with influenza requiring ICU admission or hospitalization-only are relatively rare events, their morbidity and related charges are very expensive and MRPW are over-represented among pregnant women hospitalized with influenza as compared to non-MRPW. This investigation contributed to Florida Medicaid covering influenza vaccination for MRPW. Pregnant women should continue to be encouraged to seek vaccination and receive the recommendation for vaccination from their healthcare provider.