Comparative Cost-Effectiveness Analysis of Interventions for Perinatal Methamphetamine Use Disorder: A Decision Modeling Method

OBJECTIVES: Methamphetamine use disorder (MUD) among pregnant individuals poses substantial risks to maternal and fetal health. Given the scarcity of approved treatments, exploration of off-label interventions like Naltrexone/Bupropion and non-invasive methods such as repetitive Transcranial Magnetic Stimulation (rTMS) has gained attention. This study aimed to compare the cost-effectiveness of rTMS against Naltrexone/Bupropion and no intervention for pregnant individuals diagnosed with MUD, providing valuable insights for future interventional trials targeting this demographic.

METHODS: This study assessed direct medical costs and clinical outcomes in a hypothetical cohort of 1000 pregnant individuals diagnosed with MUD, utilizing a decision tree model. Primary outcomes centered on the proportion of full-term vaginal deliveries resulting in infants of normal weight. Probabilities, costs, and adverse event data were sourced from existing literature and adjusted to 2023 US dollars. Various sensitivity analyses, including tornado diagrams and Monte Carlo simulations, were performed to gauge the robustness of the findings.

RESULTS: In the base case analysis, rTMS emerged as the dominant strategy, exhibiting the highest effectiveness at the lowest cost. Specifically, rTMS was projected to yield 760 full-term vaginal deliveries of normal-weight infants, compared to 540 for Naltrexone/Bupropion and 500 for no treatment. One-way sensitivity analysis consistently supported rTMS as the most cost-effective intervention, demonstrating stability in outcomes across various scenarios.

At or above a willingness-to-pay (WTP) threshold of $35,000, rTMS demonstrated cost-effectiveness in 100% of iterations. As the WTP threshold decreased to $10,000, rTMS and no treatment exhibited cost-effectiveness in approximately 50% of iterations, while Naltrexone/Bupropion failed to demonstrate cost-effectiveness at any WTP level.

CONCLUSIONS: This comprehensive analysis highlights the potential cost-effectiveness of rTMS as an intervention for perinatal MUD, surpassing Naltrexone/Bupropion. These findings present critical insights for healthcare decision-makers, emphasizing the need to explore rTMS in this population through well-designed interventional trials to confirm its efficacy and economic viability.