A Cost-Effectiveness Analysis of Rooming-in and Breastfeeding in Neonatal Opioid Withdrawal

Carmen M. Avram; Leah Yieh; Dmitry Dukhovny; Aaron B. Caughey

doi:10.1055/s-0039-1693716

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2020; 37(01): 001-007
DOI: 10.1055/s-0039-1693716

SMFM 2019

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Cost-Effectiveness Analysis of Rooming-in and Breastfeeding in Neonatal Opioid Withdrawal

Carmen M. Avram

¹Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon

,

Leah Yieh

²Fetal and Neonatal Institute, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California

,

Dmitry Dukhovny

¹Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon

,

Aaron B. Caughey

¹Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon

› Institutsangaben

Abstract

Objective Our cost-effectiveness analysis investigated rooming-in versus not rooming-in to determine optimal management of neonates with neonatal opioid withdrawal (NOW).

Study Design A decision-analytic model was constructed using TreeAge to compare rooming-in versus not rooming-in in a theoretical cohort of 23,200 newborns, the estimated annual number affected by NOW in the United States. Additional considerations included the effect of breast milk versus formula milk in evaluating the need for pharmacotherapy. Primary outcomes were needed for pharmacotherapy and neurodevelopment. We assumed a societal perspective in evaluating costs and maternal-neonatal quality-adjusted life years (QALYs) using a willingness-to-pay threshold of $100,000/QALY. Model inputs were derived from literature and varied in sensitivity analyses.

Results Rooming-in resulted in fewer neonates requiring pharmacotherapy when compared with not rooming-in. The rooming-in group had more neonates with intact/mild neurodevelopmental impairment and fewer cases of moderate to severe impairment. Rooming-in resulted in cost savings of $509,652,728 and 12,333 additional QALYs per annual cohort. When the risk ratio of need for pharmacotherapy in rooming-in was varied across a clinically plausible range, rooming-in remained the cost-effective strategy.

Conclusion Maternal rooming-in with newborns affected by NOW leads to reduced costs and increased effectiveness. Management strategies should optimize nonpharmacological interventions as first-line treatment.

Keywords

breastfeeding - opioid - rooming-in - withdrawal

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Referenzen

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