Cost-Effectiveness of Transcranial Magnetic Stimulation for Methamphetamine Use Disorder during Pregnancy

Area of Science:

• Obstetrics and Gynecology
• Psychiatry
• Health Economics

Background:

• Methamphetamine use disorder (MUD) in pregnancy poses significant risks for adverse maternal and perinatal outcomes.
• Limited evidence exists for effective MUD treatments in pregnant populations, including transcranial magnetic stimulation (TMS) and injectable naltrexone with bupropion.

Purpose of the Study:

• To explore the cost-effectiveness of TMS compared to injectable naltrexone with bupropion or usual care for pregnant individuals with MUD.
• To inform future clinical trial designs for TMS in pregnant MUD patients.

Main Methods:

• A decision tree model evaluated direct medical costs and clinical outcomes from pregnancy through delivery.
• Key outcomes included mode of delivery, gestational age, and infant birth weight, with a focus on full-term vaginal deliveries of normal-weight infants.
• Analysis adopted a third-party payer perspective with a $50,000 willingness-to-pay threshold.

Main Results:

• TMS demonstrated the lowest cost and highest effectiveness, achieving 76% full-term vaginal deliveries of normal-weight infants.
• Comparable outcomes for injectable naltrexone with bupropion (44%) and usual care (39%) were observed.
• Sensitivity analyses confirmed TMS as a robust, cost-effective intervention.

Conclusions:

• TMS appears to be a cost-effective option for MUD during pregnancy, potentially improving outcomes at lower costs.
• Further research is essential to confirm the safety and efficacy of TMS and other treatments in pregnant populations.
• Increased funding for clinical trials in pregnant individuals with MUD is crucial for evidence-based treatment development.