P0766 - The cost of Neonatal Abstinence Syndrome to the National Health Service: an economic analysis of a national database

Introduction
Globally, the opioid crisis has become a protracted public health problem. The crisis has negatively impacted society as a whole but disproportionately affects children. The resulting Neonatal Abstinence Syndrome (NAS) epidemic has become a pressing policy issue. This study therefore aims to explore healthcare utilization and the economic burden of NAS within the National Health Service (NHS), with a view to informing policy and practice.

Objective
To determine the incidence of Neonatal Abstinence Syndrome (NAS) managed in neonatal units across England, explore healthcare utilization within this population and estimate the direct cost to the NHS.

Methods
We performed an observational cohort study of all infants admitted to a neonatal unit in England, born between 2012-2017, who received a diagnosis of NAS. The incidence and direct costs of care associated with NAS were calculated. Using a cox proportional hazards model, the time-to-discharge was analysed. A multivariable linear model was fitted to explore mean-adjusted additional costs of care.

Results
Of 524,334 neonatal unit admissions, 6,411 had NAS. Infants with NAS accounted for 12/1,000 neonatal unit admissions and 2.3% of neonatal unit cot days nationally. The direct economic cost of caring for infants with NAS was £62,646,661: the equivalent duration of postnatal care would have equaled £34,584,633 (Table 1). The median time-to-discharge for infants requiring pharmacotherapy was 18.2 days compared to 5.1 days for those not requiring pharmacotherapy. The hazard of discharge was significantly lower for infants requiring pharmacotherapy: adjusted Hazard Ratio (aHR) 0.16 95%CI (0.15, 0.17: Table 2). The hazard of discharge was also lower for formula-fed infants aHR 0.73 (0.66, 0.81) compared to breastfed infants; those discharged to foster care aHR 0.77 (0.72, 0.82); and infants of Asian mothers aHR 0.61 (0.49, 0.77). Almost half of infants received pharmacotherapy (n=2631; 49%). The greatest predictor of additional care costs was need for pharmacotherapy, increasing additional mean-adjusted cost by £8,420.

Conclusion
This population-study highlights the substantial neonatal cot-usage and economic costs of caring for infants with NAS on neonatal units in England. Study recommendations include careful evaluation of national policy to explore routine use of postnatal wards for NAS care and increased provision of pharmacotherapy outside of the neonatal unit. A shift in how the NHS provides routine care for these infants could benefit infants and families whilst alleviating the burden on neonatal services and cost to the NHS.