A Cost-Effectiveness Analysis of Rooming-in and Breastfeeding in Neonatal Opioid WithdrawalFunding None.
02 June 2019
07 June 2019
01 August 2019 (online)
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.
This study was presented at the 39th Annual Society for Maternal Fetal Medicine Pregnancy Meeting, Las Vegas, NV, February 11–16, 2019 (poster presentation).
- 1 de Castro A, Jones HE, Johnson RE, Gray TR, Shakleya DM, Huestis MA. Maternal methadone dose, placental methadone concentrations, and neonatal outcomes. Clin Chem 2011; 57 (03) 449-458
- 2 Hudak ML, Tan RC. , Committee on Drugs, Committee on Fetus and Newborn, American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics 2012; 129 (02) e540-e560
- 3 MacMillan KDL, Rendon CP, Verma K, Riblet N, Washer DB, Volpe Holmes A. Association of rooming-in with outcomes for neonatal abstinence syndrome: a systematic review and meta-analysis. JAMA Pediatr 2018; 172 (04) 345-351
- 4 Wachman EM, Schiff DM, Silverstein M. Neonatal abstinence syndrome: advances in diagnosis and treatment. JAMA 2018; 319 (13) 1362-1374
- 5 Patrick SW, Davis MM, Lehmann CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol 2015; 35 (08) 650-655
- 6 Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA 2012; 307 (18) 1934-1940
- 7 McGlone L, Mactier H. Infants of opioid-dependent mothers: neurodevelopment at six months. Early Hum Dev 2015; 91 (01) 19-21
- 8 Merhar SL, McAllister JM, Wedig-Stevie KE, Klein AC, Meinzen-Derr J, Poindexter BB. Retrospective review of neurodevelopmental outcomes in infants treated for neonatal abstinence syndrome. J Perinatol 2018; 38 (05) 587-592
- 9 Oei JL, Melhuish E, Uebel H. , et al. Neonatal abstinence syndrome and high school performance. Pediatrics 2017; 139 (02) e20162651
- 10 Abdel-Latif ME, Pinner J, Clews S, Cooke F, Lui K, Oei J. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics 2006; 117 (06) e1163-e1169
- 11 Welle-Strand GK, Skurtveit S, Jansson LM, Bakstad B, Bjarkø L, Ravndal E. Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Acta Paediatr 2013; 102 (11) 1060-1066
- 12 Martin JA, Hamilton BE, Osterman MJ, Driscoll AK, Mathews TJ. Births: Final Data for 2015. Hyattsville, MD: National Center for Health Statistics; 2017
- 13 Holmes AV, Atwood EC, Whalen B. , et al. Rooming-in to treat neonatal abstinence syndrome: improved family-centered care at lower cost. Pediatrics 2016; 137 (06) e20152929
- 14 Abrahams RR, MacKay-Dunn MH, Nevmerjitskaia V, MacRae GS, Payne SP, Hodgson ZG. An evaluation of rooming-in among substance-exposed newborns in British Columbia. J Obstet Gynaecol Can 2010; 32 (09) 866-871
- 15 Grossman MR, Berkwitt AK, Osborn RR. , et al. An initiative to improve the quality of care of infants with neonatal abstinence syndrome. Pediatrics 2017; 139 (06) e20163360
- 16 McKnight S, Coo H, Davies G. , et al. Rooming-in for infants at risk of neonatal abstinence syndrome. Am J Perinatol 2016; 33 (05) 495-501
- 17 Beckwith AM, Burke SA. Identification of early developmental deficits in infants with prenatal heroin, methadone, and other opioid exposure. Clin Pediatr (Phila) 2015; 54 (04) 328-335
- 18 Stade B, Ali A, Bennett D. , et al. The burden of prenatal exposure to alcohol: revised measurement of cost. Can J Clin Pharmacol 2009; 16 (01) e91-e102
- 19 Lo JO, Shaffer BL, Allen AJ, Little SE, Cheng YW, Caughey AB. Intrahepatic cholestasis of pregnancy and timing of delivery. J Matern Fetal Neonatal Med 2015; 28 (18) 2254-2258
- 20 National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-Term Trends in Health 2017. Hyattsville (MD): National Center for Health Statistics; 2017
- 21 Thung SF, Funai EF, Grobman WA. The cost-effectiveness of universal screening in pregnancy for subclinical hypothyroidism. Am J Obstet Gynecol 2009; 200 (03) 267.e1-267.e7
- 22 Carroll AE, Downs SM. Improving decision analyses: parent preferences (utility values) for pediatric health outcomes. J Pediatr 2009; 155 (01) 21-25
- 23 Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness--the curious resilience of the $50,000-per-QALY threshold. N Engl J Med 2014; 371 (09) 796-797
- 24 Liu G, Kong L, Leslie DL, Corr TE. A longitudinal healthcare use profile of children with a history of neonatal abstinence syndrome. J Pediatr 2019; 204: 111-117