Methodology Consultation Success Story: Dr. Ashish Premkumar

by Sarah Gutkind, MSPH

December 9, 2019

The incidence of neonatal abstinence syndrome (NAS), also known as neonatal withdrawal syndrome, increased nationally from 3.4 per 1000 hospital births in 2009 to 5.8 in 2012. Recent estimates of NAS cost $1.5 billion dollars with the majority of the financial burden falling to state Medicaid programs. However, pregnancy offers a unique opportunity for women with opioid use disorder (OUD) to engage with the healthcare system and potentially initiate treatment for OUD.

Dr. Ashish Premkumar recently published a cost-effectiveness analysis comparing methadone, buprenorphine or detoxification with buprenorphine taper for management of OUD among pregnant women in Obstetrics and Gynecology.  Dr. Premkumar, an obstetrician and gynecologist in the Division of Maternal-Fetal Medicine in the Feinberg School of Medicine at Northwestern University, used the CHERISH Consultation Service to assist him in conducting this cost-effectiveness analysis. During the consultation with CHERISH Research Affiliate Dr. Joshua Barocas at Boston Medical Center, Dr. Premkumar obtained assistance in identifying resources and cost estimates to inform the model. The cost estimates from the literature review provided ranges for sensitivity analyses that identified key determinants of cost-effectiveness outcomes.

The study found that buprenorphine was the preferred strategy for OUD treatment during pregnancy, but the findings were sensitive to the costs of methadone and detoxification. The detoxification strategy had the highest rate of relapse and had three times more individuals switching to methadone due to repeated relapse or overdose than the buprenorphine strategy. Although detoxification resulted in fewer cases of NAS and fewer admissions to the neonatal intensive care unit, the higher costs of OUD relapse and methadone maintenance following relapse offset the cost savings associated with fewer NAS cases.