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Q&A

Healthcare Policy/Economics

Poster Session 2

(624) Contingency management for methamphetamine cessation during pregnancy: a cost-effectiveness analysis

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Methamphetamine use in pregnancy is rising and is associated with increased perinatal morbidity and mortality. Contingency management (CM) programs provide financial incentives for decreased use and are one of the most effective interventions for methamphetamine cessation in the general population. However, the use of CM during pregnancy to encourage methamphetamine cessation has not yet been studied. The objective of this study is to examine the cost-effectiveness of CM programs for pregnant individuals who use methamphetamines.

Study Design: A decision-analytic model was built to compare CM programs with psychosocial support to standard of care for pregnant individuals who use methamphetamines. We estimated a theoretical cohort of 26,000 pregnant patients who use meth annually in the United States. We assumed CM patients received $725 in incentives. Probabilities associated with methamphetamine use were adjusted for race/ethnicity, insurance status, and tobacco use. Primary outcomes included costs, quality-adjusted life years (QALYs), methamphetamine cessation in pregnancy, preeclampsia, stillbirth, preterm birth, small for gestational age (SGA) neonates, infant death, and neurodevelopmental delay. The cost-effectiveness threshold was $100,000/QALY.

Results: Contingency management was associated with methamphetamine cessation in 8,086 more individuals and a reduction of 135 stillbirths, 1,469 preterm births, 588 SGA neonates, 12 infant deaths, and 10 cases of neurodevelopmental delay. Overall, CM was the dominant strategy with decreased costs of $7 million and better outcomes with an increase of 107,290 QALYs.

Conclusion: Contingency management for methamphetamine cessation during pregnancy is a cost-effective intervention to promote abstinence from use and reduce rates of adverse pregnancy outcomes such as preterm birth and stillbirth. Implementing these programs should be considered when caring for these patients, but will need to be proactively funded.