{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:36:02Z","timestamp":1792416962916,"version":"4.4.0"},"reference-count":95,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:sec id=\"ab-poi250047-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>For the first time in nearly 2 decades, the US infant mortality rate has increased, coinciding with a rise in overdose-related deaths as a leading cause of pregnancy-associated mortality in some states. Prematurity and low birth weight\u2014often linked to opioid use in pregnancy\u2014are major contributors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi250047-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the health and economic impact of perinatal opioid use disorder (OUD) treatment on maternal and postpartum health, infant health in the first year of life, and infant long-term health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi250047-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This was a cost-effectiveness, population-based analysis using a stochastic time-to-event discrete-event simulation model to simulate the clinical progression and outcomes for hypothetical pregnant individuals with OUD who initiate treatment during pregnancy. In addition, a scenario analysis was conducted assuming that individuals were stable taking OUD treatment before pregnancy and continued treatment during pregnancy. Data were analyzed from May to September 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi250047-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Study exposures included outpatient methadone, buprenorphine monotherapy, and buprenorphine-naloxone; outpatient methadone, buprenorphine, and naltrexone after inpatient-managed withdrawal; and inpatient-managed withdrawal with and without an intensive behavioral component.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi250047-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Outcomes included return to illicit use; fatal and nonfatal overdose; incremental discounted costs; quality-adjusted life-years (QALYs), which are a combined measure of mortality and morbidity; net health benefit; infant mortality within the first year of life; preterm birth; low birth weight; and neonatal opioid withdrawal syndrome (NOWS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi250047-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In this economic evaluation of a hypothetical cohort of 100\u202f000 pregnant individuals (mean [SD] starting age, 29 [5.6] years), in the pregnancy and postpartum simulation, buprenorphine dominated all strategies, yet methadone was a viable alternative. In the combined infant lifetime model, compared with methadone, buprenorphine showed an incremental effect of 0.262 QALYs per person, totaling 20\u202f960 QALYs for 80\u202f000 Medicaid-affected mother-infant dyads (IQR uncertainty interval [UI] 25th to 75th percentiles, 14\u202f880-27\u202f040 QALYs); mean cost savings of $21\u202f512 per person, totaling $1.72 billion (IQR UI, $1.46-1.98 billion). Compared with naltrexone, buprenorphine showed an incremental effect ranging from 0.228 to 0.229 QALYs per person; 18\u202f240 of 18\u202f320 total QALYs for 80\u202f000 mother-infant dyads (IQR UI, 13\u202f840-22\u202f720 QALYs; naltrexone-oral; IQR UI, 13\u202f760-22\u202f880 QALYs; naltrexone\u2013extended release [XR]). Mean cost savings ranged from $25\u202f316 per person ($2.03 billion; IQR UI, $1.83-$2.21 billion; naltrexone-oral) to $46\u202f437 per person ($3.71 billion; IQR UI, $3.47-$3.96 billion; naltrexone-XR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi250047-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>Results of this analysis suggest that both methadone and buprenorphine remained viable options for managing OUD during pregnancy and post partum; however, buprenorphine offered the greatest benefits in the lifetime models that account for infant outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamapediatrics.2025.3067","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T15:01:05Z","timestamp":1757343665000},"page":"1203","source":"Crossref","is-referenced-by-count":4,"title":["Cost-Effectiveness of Treatment for Opioid Use Disorder in 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