Estimating the impact of neonatal abstinence system interventions on Medicaid: an incremental cost analysis

Substance Abuse Treatment, Prevention, and Policy

Paul M. Griffin¹  Diana López-Soto² 

[1] Department of Industrial Engineering, Penn State University, University Park, PA, USA;Department of Industrial Engineering, Tecnológico de Monterrey, Guadalajara, Mexico;

关键词: Neonatal abstinence syndrome;    Treatment interventions;    Incremental cost analysis;   

DOI  :  10.1186/s13011-021-00427-1

来源: Springer

【 摘 要 】

BackgroundNeonatal abstinence syndrome (NAS) incidence has significantly increased in the US in recent years. It is therefore important to develop effective intervention protocols that mitigate the long-term consequences of this condition for the mother, her child, and the community.MethodsWe used Monte Carlo simulation to estimate the impact of four interventions for NAS and their combinations on pregnant women with opioid use disorder. The key outputs were changes in incremental costs from baseline from the Medicaid perspective and from a total systems perspective and effect size changes. Simulation parameters and costs were based on the literature and baseline model validation was performed using Medicaid claims for Indiana.ResultsCompared to baseline, the resulting simulation estimates showed that three interventions significantly decreased Medicaid incremental costs by 8% (mandatory opioid testing (MOT)), 4% (patient navigators), and 3% (peer recovery coaches). The combination of the three interventions reduced Medicaid direct costs by 26%. Reductions were similar for total system incremental costs (ranging from 2 to 24%), though MOT was found to increase costs of overdose death based on productivity loss. NAS case reductions ranged from 1% (capacity change) to 13% (MOT).ConclusionsUsing systems-based modeling, we showed that costs associated with NAS can be significantly reduced. However, effective implementation would require the involvement and coordination of several stakeholders. In addition, careful protocols for MOT should be considered to ensure pregnant women don’t forgo prenatal care for fear of punitive consequences.

【 授权许可】

CC BY