Nausea and vomiting of pregnancy and resource implications: the NVP Impact Study

摘要

Background Nausea and vomiting of pregnancy (NVP) is the most prevalent medical condition associated with pregnancy. The Royal College of Obstetricians and Gynaecologists published its first guidelines for management of NVP in 2016, although many current treatments are off label, with only one recently licensed treatment for NVP in the UK.Aim To identify the current practices for NVP management across the patient pathway, and estimate the economic burden to NHS services.Design and setting This was an observational, retrospective research study conducted in the Newcastle Gateshead Clinical Commissioning Group (CCG) health economy area in England.Method Data were collected from GP practices, local hospital datasets, ambulance services (April 2013–March 2016), and the Hospital Episode Statistics dataset (2006–2016).Results Eight GP practices participated in the study. In all, 15.2% of the total pregnant population presented with NVP. Treatment varied significantly between GP practices, and 33.6% of women re-presented to their GP. There was an annual increase in women admitted to hospital for NVP symptoms, with increasing length of stay per admission. Almost half (44.6%) of the calls to 999/111 from women experiencing NVP symptoms resulted in an ambulance dispatch. The annual cost of NVP to this health economy was estimated to be ￡199 804, which crudely extrapolates to ￡25 758 731 at UK level. Due to underestimations of costs, the impact to the UK NHS could be up to ￡62 373 961.Conclusion There is considerable variation in current management practices for NVP outside of recently published guidelines, and this may result in substantial resource use and avoidable financial impact to the NHS.