The Impact of Substance Abuse Treatment Modality on Birth Weight and Health Care Expenditures

Abstract

During the 1990s, substance abuse treatment programs were developed for pregnant women to help improve infant birth outcomes, reduce maternal drug dependency and promote positive lifestyle changes. This study compared the relative impact of five treatment modalities--residential, outpatient, residential/outpatient, methadone and detoxification-only--on infant birth weight and perinatal health care expenditures for a sample of 445 Medicaid-eligible pregnant women who received treatment in Massachusetts between 1992 and 1997. Costs and outcomes were measured using the Addiction Severity Index and data from birth certificates, substance abuse treatment records and Medicaid claims. Multiple regression was used to control for intake differences between the groups. Results showed a near linear relationship between birth weight and amount of treatment received. Women who received the most treatment (the residential/outpatient group) delivered infants who were 190 grams heavier than those who received the least treatment (the detoxification-only group) for an additional cost of $17,211. Outpatient programs were the most cost-effective option, increasing birth weight by 139 grams over detoxification-only for an investment of only $1,788 in additional health care and treatment costs. A second regression using five intermediate treatment outcomes--prenatal care, weight gain, relapse, tobacco use and infection--suggested that increases in birth weight were due primarily to improved nutrition and reduced drug use, behaviors which are perhaps more easily influenced in residential settings.

Economic costs of drug abuse: Financial, cost of illness, and services

“…Maternal substance abuse is considered to have serious consequences and to increase health care expenditures (Calhoun & Watson, 1991;Chiu, Vaughn, & Carzoli, 1990;Daley et al, 2001). Epidemiologic and economic methods have been joined to measure the cost implications of births to mothers with problems in drug use, abuse, or addiction.…”

Identifying pregnant women at risk for early attrition from substance abuse treatment

“…Such treatment is associated with improved maternal and neonatal outcomes, with more intensive treatment episodes and modalities associated with the best outcomes (Daley et al, 2001;McMurtrie, Rosenberg, Kerker, Kan, & Graham, 1999). Such positive treatment outcomes include fewer positive maternal drug screens (McMurtrie et al, 1999;Svikis, Golden, et al, 1997), reduced crime (Daley et al, 2000), and improved neonatal outcomes such as higher birth weight (Daley et al, 2001;Little et al, 2003;McMurtrie et al, 1999;Svikis, Golden, et al, 1997), higher APGAR scores, and fewer and shorter neonatal intensive care unit admissions (Svikis, Golden, et al, 1997). In addition, intensive substance abuse treatment during pregnancy is associated with cost savings in terms of medical service utilization (Svikis, Golden, et al, 1997) and criminal activity (Daley et al, 2000).…”

Economic evaluation of drug abuse treatment and HIV prevention programs in pregnant women: A systematic review

“…Total benefits, measured by the avoided costs of crime net of treatment costs, spanned from $32,772 for residential only treatment to $3,072 for detoxification. In another cost-effectiveness analysis, researchers compared infant birth weights and perinatal health care spending for 445 Medicaid eligible pregnant women in Massachusetts who received one of five treatments (detoxification only, methadone, residential, outpatient, residential/outpatient) between 1992 and 1997 (15). Measurement of costs and outcomes were based on treatment records, Medicaid claims, the Addiction Severity Index (ASI), and birth certificates.…”