Economic Evaluation of Interventions for Treatment of Neonatal Opioid Withdrawal Syndrome: A Review

Abstract

This study assessed the economic evidence on the pharmacological and non-pharmacological management of infants with neonatal opioid withdrawal syndrome (NOWS). Six databases were searched up to October 2020 for peer-reviewed studies. After titles and abstracts were screened, 79 studies remained for full-text review, and finally, 8 studies were eligible for inclusion in the review. The methodological quality of included studies was assessed using the Drummond checklist. The review showed significant limitations in these studies, with one study being rated as good and the remaining seven studies as of poor quality. There are methodological issues that require addressing, including a lack of detail on cost categories, a robust investigation of uncertainty, and extending the time horizon to consider longer-term outcomes beyond the initial birth hospitalization. Despite these limitations, existing evidence suggests non-pharmacological strategies such as rooming-in were associated with a shorter hospital stay and a decreased need for pharmacological treatment, thereby lowering hospitalization costs. The review highlights the paucity of high-quality studies assessing the cost-effectiveness of intervention strategies for NOWS. There is also a lack of evidence on long-term outcomes associated with NOWS and the treatment of NOWS. The inclusion of economic analyses in future studies will provide evidence to inform policymakers on resource allocation decisions for this patient population.

Neonatal Abstinence Syndrome: Prevention, Management and Outcomes: From Birth to Adulthood

“… Overview of the themes and specific papers discussed in this Special Issue [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. …”

“…There is also a lack of evidence on long-term outcomes associated with NOWS and its treatment. The authors therefore concluded that inclusion of economic analyses in future studies is needed to provide evidence to inform policymakers on resource allocation decisions for this patient population [ 6 ]. Finally, Kim et al focused on preschool language development in NOWS children.…”

The Alberta Neonatal Abstinence Syndrome Mother-Baby Care ImprovEmeNT (NASCENT) program: protocol for a stepped wedge cluster randomized trial of a hospital-level Neonatal Abstinence Syndrome rooming-in intervention

“…The MAiN rooming-in program was safe, effective, and reduced costs by more than 50% when using non-critical care beds compared with NICU beds as the main cost driver [ 27 ]. Multiple studies corroborate these findings, identifying that nonpharmacological strategies such as rooming-in for NAS management compared to NICU care were associated with a shorter hospital LOS and a decreased need for pharmacological treatment, thereby lowering hospitalization costs [ 26 , 28 , 29 ].…”

Neonatal Opioid Withdrawal Syndrome (NOWS) Monitoring Not Requiring NICU Admissions: Examining Rooming-in as Standard Care

“…2,8 The financial burden of NOWS on health care systems is significant, as costs associated with NOWS in Canadaincluding increased LOS and NICU-were estimated at $26.9 million in 2014. 14 This current standard of care in Canada to admit infants with NOWS to NICU with continuous cardiovascular monitoring when pharmacological treatment is required exacerbates economic burdens to the health care system, and can disrupt the mother-infant dyad, which is detrimental to the development of maternal attachment, and the length and severity of NOWS symptoms. 9,15 The aim of this quality assurance project at FIR was to ensure the safety of our standard practices of MOS treatment for infants diagnosed with NOWS outside of the NICU.…”