Economic Evaluation of a Behavioral Intervention Versus Brief Advice for Substance Use Treatment in Pregnant Women: Results from a Randomized Controlled Trial

BMC Pregnancy and Childbirth, Vol. 17, 2017

8 Pages Posted: 30 Apr 2019

See all articles by Xiao Xu

Xiao Xu

Yale School of Medicine

Kimberly A. Yonkers

Yale University - Department of Psychiatry

Jennifer Prah Ruger

University of Pennsylvania - School of Social Policy & Practice; University of Pennsylvania - Perelman School of Medicine

Date Written: 2017

Abstract

Background: Substance use in pregnancy is associated with severe maternal and fetal morbidities and substantial economic costs. However, few studies have evaluated the cost-effectiveness of substance use treatment programs in pregnant women. The purpose of this study was to evaluate the economic impact of a behavioral intervention that integrated motivational enhancement therapy with cognitive behavioral therapy (MET-CBT) for treatment of substance use in pregnancy, in comparison with brief advice.

Methods: We conducted an economic evaluation alongside a clinical trial by collecting data on resource utilization and performing a cost minimization analysis as MET-CBT and brief advice had similar effects on clinical outcomes (e.g., alcohol and drug use and birth outcomes). Costs were estimated from the health care system’s perspective and included intervention costs, hospital facility costs, physician fees, and costs of psychotropic medications from the date of intake assessment until 3-month postpartum. We compared effects of MET-CBT on costs with those of brief advice using Wilcoxon rank sum tests.

Results: Although the integrated MET-CBT therapy had higher intervention cost than brief advice (median = $1297/participant versus $303/participant, p < 0.01), costs of care during the prenatal period, delivery, and postpartum period, as well as for psychotropic medications, were comparable between the two groups (all p values ≥ 0.55). There was no statistically significant difference in overall cost of care (median total cost = $26,993/participant for MET-CBT versus $27,831/participant for brief advice, p = 0.90).

Conclusions: The MET-CBT therapy and brief advice resulted in similar clinical outcomes and overall medical costs. Further research incorporating non-medical costs, targeting women with more severe substance use disorders, and evaluating the impact of MET-CBT on participants’ quality of life will provide additional insights.

Keywords: Cost Minimization Analysis, Economic Evaluation, Substance Use, Pregnancy, Randomized Controlled Trial

Suggested Citation

Xu, Xiao and Yonkers, Kimberly A. and Prah Ruger, Jennifer, Economic Evaluation of a Behavioral Intervention Versus Brief Advice for Substance Use Treatment in Pregnant Women: Results from a Randomized Controlled Trial (2017). BMC Pregnancy and Childbirth, Vol. 17, 2017, Available at SSRN: https://ssrn.com/abstract=3361923

Xiao Xu

Yale School of Medicine ( email )

310 Cedar Street
LSOG 205B, PO Box 208063
New Haven, CT 06520
United States

Kimberly A. Yonkers

Yale University - Department of Psychiatry ( email )

New Haven, CT 06520
United States

Jennifer Prah Ruger (Contact Author)

University of Pennsylvania - School of Social Policy & Practice ( email )

3701 Locust Walk
Philadelphia, PA 19104-6214
United States

University of Pennsylvania - Perelman School of Medicine

423 Guardian Drive
Philadelphia, PA 19104
United States

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