- 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.
- 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.
- 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.
- 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.