Costs of implementing a multi-site facilitation intervention to increase access to medication treatment for opioid use disorder.
Costs of implementing a multi-site facilitation intervention to increase access to medication treatment for opioid use disorder.
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DOI：
10.1186/s43058-023-00482-8
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发表时间：
2023-08-10
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美国一直在努力应对阿片类药物的流行，这导致2020年4月至2021年期间超过75，000例阿片类药物相关死亡。循证药物干预（丁丙诺啡、美沙酮和纳洛酮）可用于减少阿片类药物相关的过量和死亡。然而，由于个人和系统层面的障碍，这些药物用于阿片类药物使用障碍的采用受到抑制。外部促进是一种循证实施干预措施，已用于增加阿片类药物使用障碍（MOUD）的药物获取，但尚未评估外部促进的实施成本。我们试图衡量为MOUD实施外部促进干预的设施级直接成本，为决策者提供实施这一循证计划所需资源的估计。我们对实施前和实施阶段进行了成本分析，包括外部促进团队和当地现场劳动力成本的分项。我们使用了劳工统计局的劳动力估计值，并使用退伍军人健康管理局（VHA）财务管理系统总账数据的劳动力估计值进行了敏感性分析。每个地点实施MOUD外部便利干预的平均总成本为18，847美元（SD 6717），范围在11，320美元和31，592美元之间。这相当于每位OUD患者约48美元。遭遇战次数越多、参加者工资越高的地点，成本就越高。这主要是由参与规划和实施活动的劳动力推动的。实施前和实施活动的平均总费用分别为每个地点1 031美元和17 816美元。在敏感性分析中，VHA的成本高于劳工统计局的估计，可能是由于工资较高。实施外部便利化以增加MOUD处方可能是负担得起的，这取决于付款人的预算限制。我们的研究报告指出，在实施的每个阶段投入的时间以及参与实施外部促进干预的参与者的数量和类型都存在差异。参与者的构成在总执行成本中起着重要作用，决策者需要确定参与其执行计划的利益攸关方的最有效和最佳数量。在线版本包含补充材料，可通过10.1186/s43058-023-00482-8获得。
The United States has been grappling with the opioid epidemic, which has resulted in over 75,000 opioid-related deaths between April 2020 and 2021. Evidence-based pharmaceutical interventions (buprenorphine, methadone, and naltrexone) are available to reduce opioid-related overdoses and deaths. However, adoption of these medications for opioid use disorder has been stifled due to individual- and system-level barriers. External facilitation is an evidence-based implementation intervention that has been used to increase access to medication for opioid use disorder (MOUD), but the implementation costs of external facilitation have not been assessed. We sought to measure the facility-level direct costs of implementing an external facilitation intervention for MOUD to provide decision makers with estimates of the resources needed to implement this evidence-based program. We performed a cost analysis of the pre-implementation and implementation phases, including an itemization of external facilitation team and local site labor costs. We used labor estimates from the Bureau of Labor and Statistics, and sensitivity analyses were performed using labor estimates from the Veterans Health Administration (VHA) Financial Management System general ledger data. The average total costs for implementing an external facilitation intervention for MOUD per site was $18,847 (SD 6717) and ranged between $11,320 and $31,592. This translates to approximately $48 per patient with OUD. Sites with more encounters and participants with higher salaries in attendance had higher costs. This was driven mostly by the labor involved in planning and implementation activities. The average total cost of the pre-implementation and implementation activities were $1031 and $17,816 per site, respectively. In the sensitivity analysis, costs for VHA were higher than BLS estimates likely due to higher wages. Implementing external facilitation to increase MOUD prescribing may be affordable depending on the payer’s budget constraints. Our study reported that there were variations in the time invested at each phase of implementation and the number and type of participants involved with implementing an external facilitation intervention. Participant composition played an important role in total implementation costs, and decision makers will need to identify the most efficient and optimal number of stakeholders to involve in their implementation plans. The online version contains supplementary material available at 10.1186/s43058-023-00482-8.