Cost Effectiveness of Prenatal/postnatal Treatment/interventions for Drug Abusing Pregnant Women

» Project Details

Project Summary:

The Center for Drug Abuse Research at Howard University is proposing to conduct a cost-effectiveness study of three prenatal/postnatal treatment/interventions for substance abusing pregnant women at the Healthy Babies Project, Inc. (HBP), the Center for Addiction and Pregnancy (CAP), and the Prince George’s Hospital Center (PGHC). We postulate that care of substance abusing pregnant women is cost-effective and will provide policymakers with 1) justification for continuing public financial support of treatment/intervention programs for high-risk pregnant women; 2) assistance in determining which is a more appropriate treatment/intervention approach, and; 3) information on the most effective financial mechanisms for supporting treatment, e.g., insurance approach or direct service approach. The specific objectives of this study are to: 1) Assess the effect of prenatal/postnatal comprehensive drug abuse treatment/interventions on clinical outcomes at delivery (e.g. gestational age, Apgar scores), 2) Assess the costs of three different models of prenatal/postnatal drug abuse treatment/interventions, 3) Determine the cost-efficacy of the two models of prenatal/postnatal comprehensive services in comparison to treating drug addicted women and their infants with standard services, 4) Compare cost-efficacy of aggressive outreach (HBP) to prenatal/postnatal treatment/interventions by high risk pregnant women versus hospital, clinic, and physician referral to prenatal/postnatal treatment/interventions (CAP), and 5) Assess the policy implications of treatment/interventions for a) reducing costs borne by society, b) reducing harm to infants born to substance abusing mothers and c) enhancing access to prevention services by African American women. The study will be a retrospective comparison of cost-effectiveness of two treatment programs Group I – CAP and Group II – HBP, with standard services Group III (control) – PGHC. The women in Group I receive intensive outpatient services, and outreach is primarily by referral. Healthy Babies Project (Group II) has an aggressive outreach component targeting pregnant women in two wards of the District of Columbia and homeless women throughout the city. It provides an array of rehabilitative and case management services. Prince George’s Hospital Center (Group III) is in Maryland just across the District of Columbia border. It provides comprehensive obstetric/gynecological services through the Women’s Health Center. Based on the current patient rate we expect to find at least 130 women in each of the three groups (N=390). All women who reported medical or psychosocial problems resulting from inability to control drug use will be included in the study. In Group I and II, we will include all pregnant substance abusing women who completed intake procedures on or after January 1, 1996 and who deliver no later than January 31, 1999. Group III will be comprised of drug abusing (self-reported or positive toxicology screen) pregnant women who receive prenatal care or who present at the time of delivery on/after January 1, 1996 at the Prince George’s Hospital Center and refuse treatment services. Data will be collected by chart abstractions. Costs related to medical care of the mother and babies will be estimated for each one of the groups. Clinical outcomes will include birthweight, Apgar scores at 1 and 5 minutes, head circumference, birth length, length of stay, and length of stay in neonatal intensive care units. Continuous variables will be tested for normality. Comparison of costs between groups will be done using the Kruskal – Wallis test. Comparison of proportions between groups will be derived from the standard chi-square or Fisher tests. Statistical data analysis will be conducted using SPSS for Windows 7.5 (SPSS Inc). We will estimate the cost effectiveness of the treatment/control groups by dividing the estimated costs (in $) by the observed outcomes. The robustness of our data will be estimated using sensitivity analysis. We will use the appropriate software, i.e., DATA by TreeAge.