Abstract
ObjectivesTo determine and compare costs of a nurse-administered behavioral intervention for pregnant substance users that integrated motivational enhancement therapy with cognitive behavioral therapy (MET-CBT) to brief advice (BA) administered by an obstetrical provider. Both interventions were provided concurrent with prenatal care.MethodsWe conducted a micro-costing study that prospectively collected detailed resource utilization and unit cost data for each of the two intervention arms (MET-CBT and BA) within the context of a randomized controlled trial. A three-step approach for identifying, measuring and valuing resource utilization was used. All cost estimates were inflation adjusted to 2011 U.S. dollars.ResultsA total of 82 participants received the MET-CBT intervention and 86 participants received BA. From the societal perspective, the total cost (including participants’ time cost) of the MET-CBT intervention was $120,483 or $1,469 per participant. In contrast, the total cost of the BA intervention was $27,199 or $316 per participant. Personnel costs (nurse therapists and obstetric providers) for delivering the intervention sessions and supervising the program composed the largest share of the MET-CBT intervention costs. Program set up costs, especially intervention material design and training costs, also contributed substantially to the overall cost.ConclusionsImplementation of an MET-CBT program to promote drug abstinence in pregnant women is associated with modest costs. Future cost effectiveness and cost benefit analyses integrating costs with outcomes and benefits data will enable a more comprehensive understanding of the intervention in improving the care of substance abusing pregnant women.
Highlights
Substance use during pregnancy is a major public health problem in the United States
We conducted an economic analysis alongside an randomized controlled trial (RCT) that compared the efficacy of motivational enhancement therapy coupled with cognitive behavioral therapy (MET-CBT) to brief advice (BA) for treatment of substance use in pregnancy, reducing potentially harmful sexual behaviors, and improving birth outcomes
All cost estimates were inflation adjusted to 2011 U.S dollars using the all item and medical component of the consumer price index published by the U.S Bureau of Labor Statistics [33]
Summary
Substance use during pregnancy is a major public health problem in the United States. The survey data showed that 5.0% of pregnant women used illicit drugs in the month preceding the survey with marijuana being the most commonly used illicit drug, while 17.6% of pregnant women reported cigarette use in the past month [1]. Prenatal substance use carries adverse health consequences for both the mother and the newborn. In-utero exposure to alcohol and illicit drugs is associated with poor fetal growth, preterm birth, low birth weight, behavioral problems, and cognitive and developmental disabilities [2,3]. Illicit drug use during pregnancy increases maternal risk for HIV infection, which in turn increases the risk for perinatal transmission of HIV and adverse birth outcomes [4,5,6,7]
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