P1.194: A Payer-Perspective Economic Evaluation of the Eating, Sleeping, Consoling Care Approach for Neonatal Opioid Withdrawal

Background: Infants exposed to opioids in-utero need close monitoring and supportive care following delivery. Nationally it is estimated that 25,000 infants are affected by antenatal opioid exposure annually. The yearly cost of care for this population is estimated at 500 million USD, of which approximately 80% is covered by Medicaid. The Eating, Sleeping, Consoling care approach (ESC) has been shown to improve infant outcomes including, reduced length of stay, reduced pharmacologic treatment, reduced separation of infants and families, and increased breastfeeding, with no difference in safety outcomes. To help inform decisions around Medicaid policy and Medicaid supported programs specific to this evidence-based practice, a payer-perspective economic evaluation of the Eating, Sleeping, Consoling for Neonatal Opioid Withdrawal (ESC-NOW) study was performed to estimate the potential cost savings associated with this approach.

Methods: Patient-level costs for infants in the ESC-NOW study were constructed by applying a conventional billing scenario derived from 2025 Medicaid reimbursement which included (1) facility reimbursement using the MS-DRG system and (2) physician reimbursement for inpatient days. Study assumptions included (1) infants who received pharmacologic treatment were cared for in a monitored/NICU setting as per current AAP recommendations and (2) infants who did not receive pharmacologic treatment received care in normal newborn care settings. Transferred infants were excluded. To estimate the adjusted effect of ESC on care costs, statistical modeling accounted for study design and patient-level covariates. To match the distribution of the cost dependent variable, a generalized linear model with a gamma family distribution and a log link function was used.

Results: Descriptive statistics for the rates of NICU admission and number of NICU and non-NICU hospital days are provided in Table 1. Infants managed with ESC (n=601) were less likely to receive care in the NICU (23.8% versus 46.1%; p<.001) when compared to infants managed with usual care (n=694). Among infants who received care in the NICU, the number of NICU days was less for the ESC group (14.3 versus 17.3; p=0.011). For model-adjusted costs, care for infants managed with ESC was $3,998 USD less ($14,317 versus $18,315, p< 0.001) than for infants receiving usual care, a 22% reduction in the per patient cost.

Conclusion: Management of infants with NOWS using the evidence-based ESC care approach results in a significant cost savings to payers. Across infants in this study alone, ESC resulted in an estimated 2.4 million USD savings to payers at Medicaid reimbursement rates. Broad implementation of ESC as the standard of care would result in an estimated annual savings of ~100 million USD to Medicaid alone. These results should be considered by payers and institutions looking to support high-quality cost-efficient care for infants and families affected by opioid use disorder.