Cost-effectiveness of a motivational intervention to reduce rapid repeated childbearing in high-risk adolescent mothers: a rebirth of economic and policy considerations.
OBJECTIVE
To determine the cost-effectiveness of an intervention that successfully reduced rapid repeated births within 2 years of an index birth to adolescent mothers.


METHODS
Randomized, controlled trial conducted from February 2003 to October 2007.


METHODS
Home-based intervention with participants recruited from 5 urban clinics that provide care to low-income African American communities.


METHODS
Two hundred thirty-five pregnant teenagers (n = 235) aged 18 years or younger who were at 24 or more weeks of gestation at recruitment were followed up for 27 months.


METHODS
Participants were randomly assigned to usual care (n = 68) or 1 of 2 home-based interventions conducted by community outreach workers: (1) computer-assisted motivational intervention (CAMI) conducted quarterly with additional visits (CAMI+ [n = 80]) or (2) CAMI only (n = 87), a single-component motivational intervention conducted quarterly.


RESULTS
Additional births by 24 months post partum determined from birth certificates, total and weighted mean intervention costs, cost per participant, and incremental cost-effectiveness ratios, defined as cost per prevented repeated birth.


RESULTS
Relative to usual care, CAMI significantly reduced repeated births (adjusted odds ratio, 0.47; 95% confidence interval, 0.22-0.97). Mean intervention costs per adolescent were $2064, with incremental cost-effectiveness ratios per prevented repeated birth of $21 895 (unadjusted), $17 388 (adjusted), and $13 687 for a high-risk subgroup termed newly insured (eligible for but not enrolled in public insurance).


CONCLUSIONS
The CAMI costs and cost-effectiveness compare favorably with other effective programs aimed at preventing repeated teenage births. Replication of these results in broader samples of adolescents would provide policy guidance for what works, for whom, and at what cost.
Barnet
Beth
B
Department of Family and Community Medicine, University of Maryland School of Medicine, 29 S Paca St Lower Level, Baltimore, MD 21201, USA. bbarnet@som.umaryland.edu
Rapp
Thomas
T
DeVoe
Margo
M
Mullins
C Daniel
CD
D000293:Adolescent; D001741:Black or African American; D015142:Baltimore; D002648:Child; D003159:Community-Institutional Relations / Q000191:economics; D003201:Computers; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics* / Q000379:methods / Q000458:organization & administration; D005260:Female; D006291:Health Policy; D006699:Home Care Services / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D009042:Motivation; D011203:Poverty; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000208:ethnology / Q000517:prevention & control*