Management of nausea and vomiting in pregnancy costs the NHS more than previously thought

Reviewed by Kate Anderton, B.Sc. (Editor)Dec 17 2018

The economic cost to the NHS of vomiting and nausea during pregnancy is over £60 million, higher than previously thought, according to new estimates by the University of Warwick.

The figures are revealed in 'Nausea and vomiting of pregnancy and resource implications: the NVP Impact Study', published today (Tuesday 18 December) in the British Journal of General Practice. It is the first UK study to look at the economic costs of nausea and vomiting during pregnancy across all NHS services.

Nausea and vomiting of pregnancy (NVP) is the most prevalent medical condition during pregnancy. Up to 80% of pregnant women experience nausea and vomiting and about one quarter of these seek medical advice for their symptoms.

The paper shows variation in general practice management. The study revealed that a surprisingly high proportion of emergency 999 and 111 calls result in an ambulance being dispatched, and a hospital admission, although only a tiny proportion of cases progress to the more serious condition of hyperemesis gravidarum.

HRH the Duchess of Cambridge suffered from hyperemesis gravidarum during her three pregnancies, which has helped to bring greater awareness to the condition.

The Royal College of Obstetricians and Gynaecologists produced guidelines for managing these conditions in 2016, but this research suggests that they may not always be followed or be effective - some women consult their GP repeatedly because of persistent symptoms, and approaches to treatment vary considerably between GP practices.

Lead author Professor Roger Gadsby from Warwick Medical School said: "The main message is that nausea and vomiting in pregnancy costs the NHS more than has been realized in the past.

"Our paper shows that there is wide variation in the management at general practice level. National guidelines on the management of nausea and vomiting in pregnancy were launched in 2016 and the first medication licensed to be used in pregnancy for treating nausea and vomiting has recently been launched. Reducing variation and improving management in the community would be a great benefit to women suffering from this underappreciated condition.

"Such variation could be reduced by better advice and appropriate prescribing from healthcare professionals. This could reduce ambulance callouts and hospital admissions so reducing the cost burden to the NHS."

The researchers measured the costs in one CCG and extrapolated this to give a cost estimate for the whole of the NHS. The study focused on the Newcastle Gateshead clinical commissioning group due to its wide demographic that closely reflects the national population. Data from hospital admissions, GP surgeries and the ambulance service was incorporated into the calculations.

Professor Gadsby added: "We already knew something about the admissions costs of nausea and vomiting in pregnancy and we had an estimate of the number of hours lost to paid employment from our previous research, but this is the first time that we have estimated costs from ambulance data and from general practice contacts.

"This research demonstrates that cost savings and improvement in management are possible. It needs to be widely disseminated and understood in general practice to drive improvement in the management of the condition."