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A Rebirth of Economic and Policy Considerations

Beth Barnet, MD; Thomas Rapp, PhD; Margo DeVoe, MS; C. Daniel Mullins, PhD

Arch Pediatr Adolesc Med. 2010;164(4):370-376.

Objective  To determine the cost-effectiveness of an intervention that successfully reduced rapid repeated births within 2 years of an index birth to adolescent mothers.

Design  Randomized, controlled trial conducted from February 2003 to October 2007.

Setting  Home-based intervention with participants recruited from 5 urban clinics that provide care to low-income African American communities.

Participants  Two hundred thirty-five pregnant teenagers (n = 235) aged 18 years or younger who were at 24 or more weeks of gestation at recruitment were followed up for 27 months.

Interventions  Participants were randomly assigned to usual care (n = 68) or 1 of 2 home-based interventions conducted by community outreach workers: (1) computer-assisted motivational intervention (CAMI) conducted quarterly with additional visits (CAMI+ [n = 80]) or (2) CAMI only (n = 87), a single-component motivational intervention conducted quarterly.

Main Outcomes  Additional births by 24 months post partum determined from birth certificates, total and weighted mean intervention costs, cost per participant, and incremental cost-effectiveness ratios, defined as cost per prevented repeated birth.

Results  Relative to usual care, CAMI significantly reduced repeated births (adjusted odds ratio, 0.47; 95% confidence interval, 0.22-0.97). Mean intervention costs per adolescent were $2064, with incremental cost-effectiveness ratios per prevented repeated birth of $21 895 (unadjusted), $17 388 (adjusted), and $13 687 for a high-risk subgroup termed newly insured (eligible for but not enrolled in public insurance).

Conclusions  The CAMI costs and cost-effectiveness compare favorably with other effective programs aimed at preventing repeated teenage births. Replication of these results in broader samples of adolescents would provide policy guidance for what works, for whom, and at what cost.

Author Affiliations: Departments of Family and Community Medicine (Dr Barnet), and Family Medicine (Ms DeVoe), University of Maryland School of Medicine, Baltimore; INSERM U558, Faculté de Médecine, Toulouse, France (Dr Rapp); and Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore (Dr Mullins).

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