The impact of denying abortion access to patients with chronic kidney disease: A cost-effectiveness analysis

Objectives: The current study focuses on how abortion access affects people who are pregnant, have chronic kidney disease (CKD), and desire an abortion. From the perspective of the pregnant patient, we will examine the outcomes and costs associated with providing or refusing in-state access to abortion for this population. Study design: A decision-analytic model was built to compare the outcomes and costs associated with providing abortions in-state compared to those associated with a complete statewide abortion ban. The model includes outcomes of pregnancy with CKD and considers the progression of disease. The model also considers the likelihood and costs associated with traveling to another state for an abortion. Results: In a cohort of 31,243 pregnant people with CKD desiring an abortion, providing abortions resulted in 1350 fewer cases of preeclampsia, 2703 fewer preterm births, 4837 fewer cases of CKD stage progression, 841 fewer cases of end-stage renal disease requiring dialysis, and nine fewer deaths per year. An absence of in-state abortion access was associated with an increased cost of $533,874,448 and a decrease of 6873 quality adjusted life years (QALYs) compared to states with abortion access. Conclusion: Providing in-state abortion access to pregnant people with chronic kidney disease is a cost-effective strategy, due to the direct decrease in preeclampsia, preterm birth, mortality, and progression of kidney disease. (c) 2025 Published by Elsevier Inc.