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Cost-effectiveness of treatment for drug-abusing pregnant women |
Svikis D S, Golden A S, Huggins G R, Pickens R W, McCaul M E, Velez M L, Rosendale C T, Brooner R K, Gazaway P M, Stitzer M L, Ball C E |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Using a multidisciplinary treatment programme offering both prenatal medical and drug abuse treatment services to treatment seeking pregnant drug abusing women.
Economic study type Cost-effectiveness analysis.
Study population Active treatment-seeking andnon-treatment seeking pregnant drug abusing women.
Setting Hospital. The economic study was carried out in Baltimore, USA.
Dates to which data relate The effectiveness and resource utilisation data related to the treatment group were collected between April 1991 and October 1992. The corresponding data for the control group were gathered between April 1989 and September 1990. The fiscal year was not reported.
Source of effectiveness data Effectiveness data were derived from a single study.
Link between effectiveness and cost data The costing was retrospectively undertaken on the same patient sample as that used in the effectiveness analysis.
Study sample Power calculations were not used to determine the sample size. The treatment group consisted of 100 active treatment seeking pregnant drug abusing women with an average age of 27.7 years. The control group comprised of 46 non-treatment seeking pregnant drug abusing women with an average age of 24.6 years. The number of excluded subjects in the treatment group was 188 versus 95 in the control group.
Study design This was a non-randomised trial with historical controls, carried out in two sister hospitals within the same hospital system. The duration of the follow-up was until discharge. The dropout rate was not reported.
Analysis of effectiveness The analysis of effectiveness was based on treatment completers only since the study only included those patients who were actively participating in the treatment programme at the time of delivery. The maternal and infant clinical outcomes consisted of positive drug screen at delivery, low birthweight (<2500 g), very low birthweight (<1500 g), infant Apgar scores at 1 and 5 min., and NICU (neonatal intensive care units) hospitalisation. The groups were shown to be comparable in demographic and prognostic features except for age, education, and cocaine use, these confounding variables being controlled for in the statistical analysis.
Effectiveness results Positive drug screen at delivery was 36.8% in the treatment group versus 63.2% for the control group (adjusted p<0.001); low birthweight (<2500 g) 15% versus 39% (p<0.001); very low birthweight (<1500 g) 0% versus 17.4%;infant Apgar score at 1 minute 7.7 versus 6.8 (p<004); Apgar score at 5 minutes 8.8 versus 8.5 (p<004);NICU hospitalisation 10% versus 26% (p<0.01).
Clinical conclusions Treatment subjects showed more significant reductions in illicit drug use prior to delivery and their infants have significantly fewer medical problems than controls.
Measure of benefits used in the economic analysis No summary benefit measure was identified in the economic analysis, and only separate clinical outcomes were reported.
Direct costs The quantities were not reported separately from the costs. The cost items were broadly reported separately. The cost analysis consisted of the costs of NICU hospitalisation and drug abuse treatment. The perspective adopted in the cost analysis was not explicitly specified. The resource use data were extracted from the hospital records. The NICU hospitalisation costs were calculated based on standard rate for NICU units. The costs of drug abuse were extracted from the hospital billing record. The price date was not specified. The costs of prenatal and postnatal maternal care and costs for pediatric or other medical or drug abuse treatment services after labour and delivery were not included in the cost analysis. Costs were not discounted as they occurred over a period of less than one year.
Statistical analysis of costs Student's t test was used to compare groups in terms of costs.
Sensitivity analysis No sensitivity analysis was performed.
Estimated benefits used in the economic analysis Cost results The average total cost (in terms of average NICU cost of $1,200/day) was $7,539 for the treatment group versus $12,183 for the control group (p<0.01).
Synthesis of costs and benefits No synthesis of costs and benefits was carried out since the use of the multidisciplinary treatment programme was the dominant strategy.
Authors' conclusions The study demonstrates the cost-effectiveness of treatment for pregnant drug abusing women, with savings in NICU costs exceeding costs of drug treatment.
CRD COMMENTARY - Selection of comparators The reason for the choice of the comparator is clear. Validity of estimate of measure of effectiveness The internal validity of the estimates of effectiveness may be weakened by the lack of randomisation (albeit that this was for ethical reasons) and the fact that the analysis of effectiveness was not based on intention to treat. Validity of estimate of costs The resource utilisation was not reported separately from the costs. However adequate details of methods of cost estimation were given. The study suffered from the lack of a prospective and comprehensive cost analysis. Other issues Given the lack of randomisation, sensitivity analysis, and long-term follow-up, the study results need to be treated with some caution, as the authors themselves acknowledged. The issue of generalisability to other settings or countries was not addressed. However, appropriate comparisons with other studies were made. Implications of the study The authors pointed out that "long term follow-up studies are needed to examine the impact of drug treatment on developmental outcomes for these high-risk infants". Source of funding Supported in part by Public Health Service grant NIDA P50 DA 09258 (Behavior Therapy Treatment Research Center) and NIDA Intramural Research funds.
Bibliographic details Svikis D S, Golden A S, Huggins G R, Pickens R W, McCaul M E, Velez M L, Rosendale C T, Brooner R K, Gazaway P M, Stitzer M L, Ball C E. Cost-effectiveness of treatment for drug-abusing pregnant women. Advanced Drug Delivery Reviews 1997; 45(1-2): 105-113 Indexing Status Subject indexing assigned by NLM MeSH Adult; Apgar Score; Cost-Benefit Analysis; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal /economics; Pregnancy; Pregnancy Complications /psychology /economics /therapy; Pregnancy Outcome /economics; Psychiatric Status Rating Scales; Research Support, U.S. Gov't, P.H.S.; Substance-Related Disorders /psychology /economics /therapy; Treatment Outcome AccessionNumber 21997006954 Date bibliographic record published 31/07/1999 Date abstract record published 31/07/1999 |
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