Costs of a motivational enhancement therapy coupled with cognitive behavioral therapy versus brief advice for pregnant substance users.
OBJECTIVE
To determine and compare costs of a nurse-administered behavioral intervention for pregnant substance users that integrated motivational enhancement therapy with cognitive behavioral therapy (MET-CBT) to brief advice (BA) administered by an obstetrical provider. Both interventions were provided concurrent with prenatal care.


METHODS
We conducted a micro-costing study that prospectively collected detailed resource utilization and unit cost data for each of the two intervention arms (MET-CBT and BA) within the context of a randomized controlled trial. A three-step approach for identifying, measuring and valuing resource utilization was used. All cost estimates were inflation adjusted to 2011 U.S. dollars.


RESULTS
A total of 82 participants received the MET-CBT intervention and 86 participants received BA. From the societal perspective, the total cost (including participants' time cost) of the MET-CBT intervention was $120,483 or $1,469 per participant. In contrast, the total cost of the BA intervention was $27,199 or $316 per participant. Personnel costs (nurse therapists and obstetric providers) for delivering the intervention sessions and supervising the program composed the largest share of the MET-CBT intervention costs. Program set up costs, especially intervention material design and training costs, also contributed substantially to the overall cost.


CONCLUSIONS
Implementation of an MET-CBT program to promote drug abstinence in pregnant women is associated with modest costs. Future cost effectiveness and cost benefit analyses integrating costs with outcomes and benefits data will enable a more comprehensive understanding of the intervention in improving the care of substance abusing pregnant women.
Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Yale University, New Haven, Connecticut, United States of America.
Xiao
X
Xu
Department of Psychiatry and Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, Yale University, New Haven, Connecticut, United States of America.
Kimberly A
KA
Yonkers
Yale University, Department of Health Policy and Management, New Haven, CT Department of Public Health, School of Medicine, Yale University, New Haven, Connecticut, United States of America.
Jennifer P
JP
Ruger
D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods*; D003131:Combined Modality Therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D055030:Drug Users; D005260:Female; D017048:Health Care Costs; D006801:Humans; D009042:Motivation; D011247:Pregnancy; D019966:Substance-Related Disorders / Q000628:therapy