Buprenorphine is most cost-effective for opioid use disorder during pregnancy

  • Premkumar A & al.
  • Obstet Gynecol
  • 8 Oct 2019

  • International Clinical Digest
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Takeaway

  • Opioid use disorder (OUD) during pregnancy is most economically treated with buprenorphine.

Why this matters

  • OUD is a public health issue that has been increasing during pregnancy.
  • OUD during pregnancy is associated with neonatal abstinence syndrome, affecting 20,000 neonates per year.
  • Historically, withdrawal from opioids during pregnancy has been associated with miscarriage and stillbirth, but recent studies have not been able to confirm this.

Key results

  • Buprenorphine was associated with $8827 savings per person when compared with methadone, and $23,647 savings per person when compared with detoxification.
  • Buprenorphine was associated with higher total quality-adjusted life years (QALYs) for a lower cost per QALY compared with methadone or detoxification.
  • The highest estimated relapse rate was in the detoxification group.
  • The lowest rate of neonatal abstinence syndrome was in the detoxification group.

Study design

  • Decision-tree model from a health care payor perspective used to compare 3 strategies (buprenorphine, methadone, and detoxification) to manage OUD after 16 weeks of pregnancy.
  • Baseline probabilities and outcomes of each strategy were based on estimates from the literature.
  • Funding: None disclosed.

Limitations

  • Does not take into account any contraindications to any of the 3 strategies.
  • Long-term childhood outcomes and costs with exposure in utero to buprenorphine not calculated.