Management of opiate-dependence in pregnancy can include detoxification and maintenance therapy with methadone or buprenorphine. Traditionally, detoxification was associated with higher rates of fetal and neonatal death but recent studies have challenged this relationship. The purpose of this study is to assess the cost-effectiveness of detoxification compared to methadone maintenance therapy.METHODS:
A decision-analytic model using TreeAge Pro was designed to compare detoxification with methadone maintenance therapy. All probabilities and utilities were derived from the literature. Utilities were included with a discounted life expectancy rate of 3% to produce quality adjusted life years (QALYs). The cost-effectiveness threshold was set at $100,000 per QALY. Prenatal outcomes examined included intrauterine fetal demise (IUFD), neonatal demise (NND), perinatal deaths, neonatal abstinence syndrome (NAS), major neurodevelopmental disorder (MNDD), and preterm delivery (PTD). The maternal outcome measured was opioid relapse rate.RESULTS:
We found that that detoxification was the dominant methodology for all outcomes assessed. In a theoretical cohort of 10,000 opiate-dependent pregnant woman, detoxification resulted in 59 fewer treatment failures, 26 fewer perinatal deaths, 4282 fewer cases of NAS, 137 fewer cases of MNDD, 224 fewer PTDs, and savings of $3,363 per pregnancy. Sensitivity analysis demonstrated that detoxification was the dominant strategy up to a detoxification price of $14,750, and remained cost-effective to a detoxification price of $26,357.CONCLUSION:
Detoxification in pregnancy results in improved maternal and fetal outcomes, and is the cost-effective strategy when compared to methadone maintenance therapy.