Early Start: A cost beneficial perinatal substance abuse program

Substance use remains a significant problem in pregnancy, leading to preventable morbidity and mortality. Cost effective interventions are needed. The purpose of this study was to conduct a cost-benefit analysis of Early Start (ES), an integrated, prenatal intervention program for stopping substance use in pregnancy. A retrospective cohort study was conducted of 49,261 women who completed Prenatal Substance Abuse Screening Questionnaires at obstetric clinics and had urine toxicology screening tests. Four study groups were compared: women screened/assessed positive and followed by ES (“SAF”,n=2032); women screened/assessed positive without follow-up (“SA”,n=1181); women screened positive only (“S”,n=149); controls who screened negative (“C”,n=45,899). Costs associated with maternal healthcare (prenatal through one year post-partum), infant birth hospitalization care, and pediatric healthcare (through one year) were adjusted to 2009 dollars. Mean costs were calculated, adjusted for age, race, education, income, marital status and amount of prenatal care. S group adjusted mean maternal total costs ($10,869) were significantly higher than SAF, SA and C groups ($9,430, $9,230, $8,282; all p<0.0001). S group adjusted mean infant total costs ($16,943) were significantly higher than SAF, SA, and C groups ($11,214, $11,304, $10,416; all p<0.0001). S group adjusted mean overall total costs ($27,812) were significantly higher than SAF, SA, and C groups ($20,644, $20,534, $18,698; all p<0.0001). Cost-benefit analysis showed that the net cost benefit averaged $5,946,741/year. Early Start is a cost-beneficial intervention for substance use in pregnancy that improves maternal-infant outcomes and leads to lower overall costs by an amount significantly greater than the costs of the program.