Cost-effectiveness of emergency department-initiated treatment for opioid dependence.
Cost-effectiveness of emergency department-initiated treatment for opioid dependence.
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DOI：
10.1111/add.13900
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
D'Onofrio G
中科院分区：
文献类型：
--
作者：
Busch SH;Fiellin DA;Chawarski MC;Owens PH;Pantalon MV;Hawk K;Bernstein SL;O'Connor PG;D'Onofrio G
在最近的一项随机试验中，接受短暂干预、急诊科（艾德）启动的丁丙诺啡治疗以及在初级保健中持续随访丁丙诺啡（丁丙诺啡）的阿片类药物依赖患者参与成瘾治疗的可能性是转诊至社区治疗（转诊）或短暂干预和转诊（短暂干预）的两倍。我们的目的是评估这3种方法干预ED中阿片类药物依赖的相对成本效益。将测量的医疗保健使用转换为美元价值。我们考虑了医疗保健系统的角度来看，并构建了成本效益的可接受性曲线，表明每种治疗的概率是成本效益的不同阈值下的愿意支付的结果研究。美国的一个城市艾德。18岁或以上的阿片类药物依赖患者。自我报告的30天评估数据用于构建患者在30天内参与正式成瘾治疗的成本效益可接受性曲线以及过去一周内无非法阿片类药物的天数。仅考虑医疗保健系统成本，成本效益可接受性曲线表明，在所有积极的支付意愿值，ED启动的丁丙诺啡治疗比简短的干预或转诊更具成本效益。例如，在30天治疗的支付意愿阈值为1000美元时，我们有79%的把握认为ED引发的丁丙诺啡与其他研究治疗相比是最具成本效益的。在过去的一周里，没有非法阿片类药物的日子也有类似的结果。结果是强大的二次分析，包括患者缺失的成本数据，包括犯罪和病人的时间成本的分子，并在单位价格估计的变化。在美国，急诊部门启动的阿片类药物依赖患者的丁丙诺啡干预与转介到社区治疗或短期干预和转介相结合相比，提供了很高的价值。
In a recent randomized trial, patients with opioid dependence receiving brief intervention, Emergency Department (ED)-initiated buprenorphine, and ongoing follow up in primary care with buprenorphine (buprenorphine) were twice as likely to be engaged in addiction treatment compared with referral to community-based treatment (referral) or brief intervention and referral (brief intervention). Our aim was to evaluate the relative cost effectiveness of these 3 methods of intervening on opioid dependence in the ED. Measured healthcare use was converted to dollar values. We considered a health care system perspective and constructed cost effectiveness acceptability curves that indicate the probability each treatment is cost effective under different thresholds of willingness-to-pay for outcomes studied. An urban ED in the USA. Opioid-dependent patients 18 years or older. Self-reported 30-day assessment data were used to construct cost effectiveness acceptability curves for patient engagement in formal addiction treatment at 30 days and the number of days illicit opioid free in the past week. Considering only health care system costs, cost effectiveness acceptability curves indicate that at all positive willingness-to-pay values, ED-initiated buprenorphine treatment was more cost-effective than brief intervention or referral. For example, at a willingness-to-pay threshold of $1000 for 30-day treatment engagement, we are 79 percent certain ED-initiated buprenorphine is most cost effective compared with other studied treatments. Similar results were found for days illicit opioid free in the past week. Results were robust to secondary analyses that included patients with missing cost data, included crime and patient time costs in the numerator, and to changes in unit price estimates. In the United States, emergency department-initiated buprenorphine intervention for patients with opioid dependence provides high value compared with referral to community-based treatment or combined brief intervention and referral.
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1.8
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Bray, Jeremy W.;Mallonee, Erin;Vendetti, Janice
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