{
  "site": "The Missing Weeks",
  "url": "https://themissingweeks.org",
  "publisher": "AEXTech Holdings",
  "disclosure": "Published by AEXTech Holdings. Its founder, Alex Rogers, holds shares in Sera Prognostics, maker of the PreTRM mid-pregnancy risk test that appears on the timeline, and has an interest in a Blue Ox Healthcare Partners vehicle holding Sera warrants; he expects to have a stake in iMSO, a new company that plans to sell preterm-birth prevention programs using that test. Sera did not fund, review or see the site. AEXTech also sells a fuller version of the model behind it. Full text: https://themissingweeks.org/about",
  "notAdvice": "Population and program planning references, not individual medical, actuarial or legal advice.",
  "state": {
    "id": "TX",
    "name": "Texas",
    "births": 387945,
    "pretermRatePct": 11.13,
    "pretermBirths": 43172,
    "medicaidSharePct": 45
  },
  "inputs": {
    "births": {
      "value": 387945,
      "label": "CDC/NCHS, Births: Final Data for 2023 (NVSR 74-1), Table 6",
      "vintage": 2023,
      "grade": "validated",
      "url": "https://www.cdc.gov/nchs/data/nvsr/nvsr74/nvsr74-1.pdf"
    },
    "pretermRatePct": {
      "value": 11.13,
      "label": "CDC/NCHS, Births: Final Data for 2023 (NVSR 74-1), Internet Table XV (preterm, <37 weeks, obstetric estimate, by state of residence)",
      "vintage": 2023,
      "grade": "validated",
      "url": "https://www.cdc.gov/nchs/data/nvsr/nvsr74/nvsr74-1.pdf"
    },
    "costPerPretermBirth": {
      "value": 64815,
      "label": "Waitzman NJ, Jalali A, Grosse SD. Preterm birth lifetime costs in the United States in 2016: an update. Semin Perinatol 2021;45(3):151390",
      "unit": "USD 2016, average lifetime cost per preterm birth, all severities, not annual, not inflated",
      "grade": "validated",
      "url": "https://doi.org/10.1016/j.semperi.2021.151390"
    },
    "inCarePct": {
      "value": 76,
      "label": "NCHS Data Brief 507: 76.1% of U.S. mothers began prenatal care in the first trimester in 2023 (national; state figures are in the NVSR tables)",
      "grade": "validated",
      "url": "https://www.cdc.gov/nchs/products/databriefs/db507.htm"
    },
    "sharePct": {
      "value": 55,
      "label": "Research-consent rates in the screen-and-treat trials ran 55-73%; real-world clinical uptake is not yet published",
      "grade": "plausible"
    },
    "effectPct": {
      "value": 5,
      "label": "A dial, set by the reader and set from no single intervention. Effects hold in subgroups (e.g. vaginal progesterone RR 0.78 for preterm birth <34 weeks in short-cervix singletons, EPPPIC 2021)",
      "grade": "assumption"
    },
    "costPerPregnancyUSD": {
      "value": 60,
      "label": "A dial. For a screen-and-treat program: the screen's cost per pregnancy plus the total cost of treatment divided by the number of pregnancies screened",
      "grade": "assumption"
    }
  },
  "results": {
    "pretermBirthsPerYear": 43178,
    "lifetimeCostOfOneYearsPretermBirthsUSD": 2798600121,
    "pregnanciesInCareInTime": 294838,
    "pregnanciesTreated": 162161,
    "pretermBirthsPreventedPerYear": 902,
    "lifetimeCostAvoidedPerYearUSD": 58490743,
    "programCostPerYearUSD": 9729661,
    "netValuePerYearUSD": 48761082,
    "valueReturnedPerDollar": 6.01,
    "pregnanciesArrivingAfterFirstTrimester": 93107,
    "pretermBirthsAmongThemTheProgramWouldHavePrevented": 285,
    "missingWeeksCostUSD": 18470761
  },
  "units": "Dollars are 2016 USD lifetime costs (Waitzman 2021), not annual budgets and not inflated. Counts are per year of births.",
  "formula": [
    "preterm births      = births × rate                      = 387,945 × 11.1% = 43,178",
    "cost as it stands   = preterm births × $64,815            = $2.80B",
    "reached in time     = births × in-care share              = 387,945 × 76% = 294,838",
    "treated             = reached × program share             = 162,161",
    "prevented           = treated × rate × effect             = 162,161 × 11.1% × 5% = 902",
    "cost avoided        = prevented × $64,815                 = $58.5M",
    "program cost        = treated × $60 per pregnancy            = $9.7M",
    "net                 = cost avoided − program cost         = $48.8M",
    "arrived late        = births × (1 − in-care share)        = 93,107",
    "missing weeks cost  = late × program share × rate × effect × $64,815 = $18.5M"
  ],
  "caveats": [
    "The $64,815 is an average lifetime cost (2016 dollars) across all severities, a civic-scale number. A payer pricing a contract uses acute cost by gestational-age band, which is lower and sharper.",
    "The effect dial does the work. Each intervention works in a subgroup; a population-wide effect is the reader's assumption, not a finding. Whatever it is set to, the answer is no better than the reason for setting it.",
    "The in-care default is a national first-trimester figure. Some windows stay open past the first trimester, so it understates the share in time for those, and overstates what the missing weeks cost.",
    "The missing-weeks figure assumes late entrants respond to the program as the others do. That is an assumption, not a finding: pregnancies that enter care late may carry different risks.",
    "No risk stratification, no demographic weighting, no cost-by-week schedule. Those change the answer and belong in a payer's actuarial review."
  ],
  "page": "https://themissingweeks.org/calculator?s=TX&inCare=76&share=55&effect=5&cost=60"
}