Costs of a Motivational Enhancement Therapy Coupled with Cognitive Behavioral Therapy versus Brief Advice for Pregnant Substance Users

Xu, Xiao; Yonkers, Kimberly A.; Ruger, Jennifer Prah

doi:10.1371/journal.pone.0095264

Cited by 61 publications

(9 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Assessment only visits occurred at intake, delivery, 3-months post-delivery, 12-months post-delivery, and 24-months post- delivery. The 12-month and 24-month visits and data collection were also part of an economic evaluation, the results of which are reported elsewhere (Xu et al, 2014). …”

Section: Methodsmentioning

confidence: 99%

Perinatal substance use: A prospective evaluation of abstinence and relapse

Forray¹,

Merry²,

Lin³

et al. 2015

Drug and Alcohol Dependence

Self Cite

118

View full text Add to dashboard Cite

Background Substance use decreases in pregnancy but little prospective data are available on the rates of abstinence and relapse for specific substances. This study compared rates of abstinence in pregnancy and relapse postpartum for nicotine cigarettes, alcohol, marijuana, and cocaine. Methods Data from 152 women drawn from a randomized controlled trial comparing psychological treatments for substance use in pregnancy were analyzed. Self-reports of substance use and urine for toxicology testing throughout pregnancy and 3-months, 12-months and 24-months post-delivery were collected. Multivariate Cox models were used to compare rates of abstinence and relapse across substances. Results In pregnancy, 83% of all women achieved abstinence to at least one substance. The mean (SE) days to abstinence was 145.81 (9.17), 132.01 (6.17), 151.52 (6.24), and 148.91 (7.68) for cigarettes, alcohol, marijuana and cocaine, respectively. Participants were more likely to achieve abstinence from alcohol (HR 7.24 (95% CI 4.47-11.72), marijuana (HR 4.06; 95% CI 1.87-6.22), and cocaine (HR 3.41; 95% CI 2.53-6.51), than cigarettes. Postpartum, 80% of women abstinent in the last month of pregnancy relapsed to at least one substance. The mean days to relapse was 109.67 (26.34), 127.73 (21.29), 138.35 (25.46), and 287.55 (95.85) for cigarettes, alcohol, marijuana and cocaine, respectively. Relapse to cocaine was only 34% (HR 0.34; 95% CI 0.15-0.77) that of cigarettes. Conclusions Pregnancy-related abstinence rates were high for all substances except cigarettes. Postpartum relapse was common, with cocaine using women being less likely to relapse after attaining abstinence compared to women using cigarettes, alcohol or marijuana.

show abstract

Section: Methodsmentioning

confidence: 99%

Perinatal substance use: A prospective evaluation of abstinence and relapse

Forray¹,

Merry²,

Lin³

et al. 2015

Drug and Alcohol Dependence

Self Cite

118

View full text Add to dashboard Cite

show abstract

“…Units of input can be defined based on the intervention and could include, for example, an hour of nurse time or a percentage of a nurse’s total time for labour, square foot for facilities space and individual booklet for programme educational materials. Micro-costing comprises five primary steps (other investigators have itemised methods from 3 to 6 steps10 19 20 25 but the major principles remain the same): 1) define the intervention production processes and the study perspective; 2) identify the intervention inputs; 3) quantify the units of each input; 4) assign a cost value to each input unit and aggregate and 5) conduct sensitivity analysis. Under the umbrella of micro-costing methods, different approaches with varying degrees of precision exist.…”

Section: Intervention Costs and Costing Methodsmentioning

confidence: 99%

“…However, few have provided adequate focus on methods for intervention cost estimation,15–17 and none has been developed with sufficient detail for thorough direct measurement techniques such as micro-costing,18 the most accurate and precise costing method 7. While defined consensus standards and guidelines have yet to be developed for conducting micro-costing studies, the principles are well established and discussed in the literature 7 8 10 19 20. Even so, discussion of the available data collection tools and methods used to conduct micro-costing studies has been limited and tends to focus on clinical settings and health technology,17 21 with less attention placed on public health interventions such as those for the prevention and management of chronic conditions 10 19…”

Section: Introductionmentioning

confidence: 99%

Understanding cost data collection tools to improve economic evaluations of health interventions

Chapel

Wang

2019

Stroke Vasc Neurol

View full text Add to dashboard Cite

Micro-costing data collection tools often used in literature include standardized comprehensive templates, targeted questionnaires, activity logs, on-site administrative databases, and direct observation. These tools are not mutually exclusive and are often used in combination. Each tool has unique merits and limitations, and some may be more applicable than others under different circumstances. Proper application of micro-costing tools can produce quality cost estimates and enhance the usefulness of economic evaluations to inform resource allocation decisions. A common method to derive both fixed and variable costs of an intervention involves collecting data from the bottom up for each resource consumed (micro-costing). We scanned economic evaluation literature published in 2008-2018 and identified micro-costing data collection tools used. We categorized the identified tools and discuss their practical applications in an example study of health interventions, including their potential strengths and weaknesses. Sound economic evaluations of health interventions provide valuable information for justifying resource allocation decisions, planning for implementation, and enhancing the sustainability of the interventions. However, the quality of intervention cost estimates is seldom addressed in the literature. Reliable cost data forms the foundation of economic evaluations, and without reliable estimates, evaluation results, such as cost-effectiveness measures, could be misleading. In this project, we identified data collection tools often used to obtain reliable data for estimating costs of interventions that prevent and manage chronic conditions and considered practical applications to promote their use.

show abstract

“…Because this timeframe was less than 1 year, no discounting was needed. Intervention costs were determined using a micro-costing technique taking into consideration the quantity and unit price of all inputs used for the design and implementation of the MET-CBT intervention and brief advice [ 18 ]. Research-induced costs during the intervention (e.g., staff time spent on data entry) were excluded.…”

Section: Methodsmentioning

confidence: 99%

Economic evaluation of a behavioral intervention versus brief advice for substance use treatment in pregnant women: results from a randomized controlled trial

Yonkers

Ruger

2017

BMC Pregnancy Childbirth

Self Cite

View full text Add to dashboard Cite

BackgroundSubstance use in pregnancy is associated with severe maternal and fetal morbidities and substantial economic costs. However, few studies have evaluated the cost-effectiveness of substance use treatment programs in pregnant women. The purpose of this study was to evaluate the economic impact of a behavioral intervention that integrated motivational enhancement therapy with cognitive behavioral therapy (MET-CBT) for treatment of substance use in pregnancy, in comparison with brief advice.MethodsWe conducted an economic evaluation alongside a clinical trial by collecting data on resource utilization and performing a cost minimization analysis as MET-CBT and brief advice had similar effects on clinical outcomes (e.g., alcohol and drug use and birth outcomes). Costs were estimated from the health care system’s perspective and included intervention costs, hospital facility costs, physician fees, and costs of psychotropic medications from the date of intake assessment until 3-month postpartum. We compared effects of MET-CBT on costs with those of brief advice using Wilcoxon rank sum tests.ResultsAlthough the integrated MET-CBT therapy had higher intervention cost than brief advice (median = $1297/participant versus $303/participant, p < 0.01), costs of care during the prenatal period, delivery, and postpartum period, as well as for psychotropic medications, were comparable between the two groups (all p values ≥ 0.55). There was no statistically significant difference in overall cost of care (median total cost = $26,993/participant for MET-CBT versus $27,831/participant for brief advice, p = 0.90).ConclusionsThe MET-CBT therapy and brief advice resulted in similar clinical outcomes and overall medical costs. Further research incorporating non-medical costs, targeting women with more severe substance use disorders, and evaluating the impact of MET-CBT on participants’ quality of life will provide additional insights.Trial registrationClinicalTrials.gov NCT00227903. Registered 27 September 2005.

show abstract

Costs of a Motivational Enhancement Therapy Coupled with Cognitive Behavioral Therapy versus Brief Advice for Pregnant Substance Users

Cited by 61 publications

References 34 publications

Perinatal substance use: A prospective evaluation of abstinence and relapse

Perinatal substance use: A prospective evaluation of abstinence and relapse

Understanding cost data collection tools to improve economic evaluations of health interventions

Economic evaluation of a behavioral intervention versus brief advice for substance use treatment in pregnant women: results from a randomized controlled trial

Contact Info

Product

Resources

About