JAMA Pediatr

Buprenorphine in pregnancy: Cost-effective with better birth outcomes

September 17, 2025

Study details: This 2025 economic analysis used a stochastic time-to-event simulation to model outcomes for 100,000 hypothetical, treatment-naive pregnant individuals with opioid use disorder (OUD). The study compared outpatient methadone, buprenorphine (monotherapy and buprenorphine-naloxone), naltrexone (oral and extended-release), and inpatient-managed withdrawal, evaluating each strategy across pregnancy, postpartum, and infant lifetime horizons. Outcomes included return to illicit opioid use, overdose, incremental costs, quality-adjusted life-years (QALYs), and incremental net health benefit.

Results: Buprenorphine consistently outperformed all other strategies across maternal, infant, and lifetime health outcomes. Compared with methadone, buprenorphine added 0.262 QALYs per person and saved $21,512 each—totaling $1.72 billion across 80,000 Medicaid-covered dyads. Compared with naltrexone, buprenorphine yielded up to $46,437 in savings per person and over $3.7 billion total. It also reduced risks of preterm birth, low birth weight, and neonatal opioid withdrawal syndrome.

Clinical impact: These findings reinforce buprenorphine as the preferred first-line pharmacotherapy for OUD in pregnancy, offering both superior clinical outcomes and economic value. Expanding access to buprenorphine-based treatment could substantially reduce adverse birth outcomes and healthcare costs in this high-risk population.

Source:

Leech AA, et al. (2025, September 8). JAMA Pediatr. Cost-Effectiveness of Treatment for Opioid Use Disorder in Pregnancy and Its Impact on Birth Outcomes. https://pubmed.ncbi.nlm.nih.gov/40920396/