The Economic Viability and Value of Implementing an Inpatient Addiction Consult Model in Public Hospital Systems for Patients with Opioid Use Disorder

在公立医院系统中为阿片类药物使用障碍患者实施住院成瘾咨询模式的经济可行性和价值

• 批准号: 10575853
• 负责人: Ali Jalali
• 金额: $ 10.21万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10575853
• 关键词: Accounting; Adopted; Ambulatory Care; Attenuated; Budgets; Buprenorphine; Caring; Clinical Trials; Communities; Consult; Consultations; Data; Decision Making; Economics; Effectiveness; Electronic Health Record; Ensure; Environment; Evidence based treatment; Expenditure; Funding; Goals; HIV; Health; Health Care Costs; Health Expenditures; Health Services Accessibility; Health system; Healthcare; Hepatitis C virus; Hospital Administrators; Hospitalization; Hospitals; Individual; Inpatients; Intervention; Lead; Link; Measures; Medicaid; Methadone; Modeling; Municipal Hospitals; Naltrexone; National Institute of Drug Abuse; New York City; Opioid; Outcome; Outpatients; Parents; Participant; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Pharmacologic Substance; Pharmacotherapy; Policy Maker; Population; Premature Mortality; Professional counselor; Public Hospitals; Quality-Adjusted Life Years; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research Infrastructure; Research Personnel; Resource Allocation; Resources; Services; Site; Social Workers; Societies; Substance Use Disorder; System; Use Effectiveness; Work; acute care; addiction; barrier to care; beneficiary; budget impact; care costs; care systems; community based treatment; comparative; cost; cost effective; cost estimate; cost-effectiveness evaluation; economic evaluation; economic value; effectiveness measure; effectiveness/implementation trial; evidence base; health care model; health care service; health care service utilization; health economics; implementation evaluation; implementation outcomes; improved; interest; intervention cost; opioid epidemic; opioid overdose; opioid use disorder; overdose death; peer; prospective; research to practice; safety net; secondary analysis; social; societal costs; study population; tool; treatment as usual; unemployment insurance

Project Summary An estimated 1.6 million persons in the US suffer from an opioid use disorder (OUD), which costs society $787 billion a year resulting from excess healthcare expenditures and societal resources. Evidence-based treatments for OUD have been shown to improve health and attenuate healthcare costs, but utilization continues to be low. Models of hospital-inpatient addiction consultation and linkage to community-based treatment following discharge have preliminarily demonstrated effectiveness; however, little is known about the economic value or sustainability of such models in public hospital settings. In 2018, to improve post-discharge utilization of evidence-based pharmacotherapy for OUD, New York City Health & Hospitals, the largest municipal hospital system in the US, introduced the Consult for Addiction Treatment and Care in Hospitals (CATCH) intervention. CATCH is an addiction consult model which evaluates individuals with an opioid-related hospitalization for OUD, initiates pharmacotherapy when indicated, and directly links patients to post-discharge treatment. An ongoing NIDA-funded hybrid effectiveness-implementation trial is evaluating CATCH with regard to increased treatment engagement, acute care utilization, and collecting implementation outcomes within the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, the most widely applied framework for measuring the impact of an intervention in real world environments. The study’s economic component focuses on estimating the intervention costs and potential cost-offsets resulting from reductions in acute care utilization and premature mortality. However, the participant population is primary composed of Medicaid beneficiaries and key stakeholders will benefit from expanded economic information (additional healthcare paid by Medicaid, social safety-net expenditures funded via state budgets) and tools to evaluate the viability of CATCH in a representative setting. This project will leverage the research infrastructure of the aforementioned study to substantially increase the economic information available to stakeholders, most specifically those who are largely responsible for making treatment-access decisions on behalf of the study population, i.e., policymakers. This project will estimate the costs required to implement and sustain the CATCH intervention utilizing data already collected as part of the parent study to build a customizable budget impact tool that allows costs to be calculated for each component of the RE-AIM framework for stakeholders (e.g., other public hospitals). The project will also estimate the economic value of CATCH relative to treatment-as-usual from a state policymaker perspective by incorporating: 1) nationally representative Medicaid unit costs of healthcare services 2) Medicaid claims data on ambulatory care services, dispensed pharmaceuticals, and subsequent treatment for OUD in community and outpatient settings as part of the total cost of the CATCH intervention; and 3) additional non-healthcare social safety-net expenditures to support comparative assessment and resource allocation decisions by stakeholders.

项目摘要 据估计，美国有160万人患有阿片使用障碍(OUD)，这给社会造成了787美元的损失 每年因过度的医疗支出和社会资源而产生的数十亿美元。循证治疗 因为我们已被证明可以改善健康和降低医疗成本，但利用率仍然很低。 院内戒毒咨询与社区戒毒后续联动模式研究 排放已初步证明是有效的；然而，人们对其经济价值或 这种模式在公立医院环境中的可持续性。2018年，提高出厂后利用率 纽约市最大的市立医院OUD的循证药物治疗 美国的成瘾治疗和护理咨询系统(CATCH)干预措施。 Catch是一个成瘾咨询模型，它评估与阿片类药物相关的OUD住院患者， 根据需要启动药物治疗，并直接将患者与出院后治疗联系起来。一个正在进行的 NIDA资助的混合有效性实施试验正在评估与增加治疗有关的CATCH 参与度、急性护理利用率和收集可及范围内的实施成果、有效性、 采用、实施和维护(RE-AIM)框架，是应用最广泛的 衡量干预对现实世界环境的影响。这项研究的经济部分集中在 估计急诊护理使用率减少所产生的干预成本和潜在成本抵销 和过早死亡。然而，参与人群主要由医疗补助受益人和 主要利益相关者将从扩展的经济信息中受益(额外的医疗保健由医疗补助、社会 由国家预算提供资金的安全网支出)和评估代表性渔获物可行性的工具 布景。该项目将利用上述研究的研究基础设施大幅增加 利益相关者可获得的经济信息，尤其是那些在很大程度上对 代表研究人群，即政策制定者，作出获得治疗的决定。这个项目将 利用已经收集的数据估计实施和维持捕捞干预措施所需的成本 父研究的一部分，用于构建可定制的预算影响工具，该工具允许计算每个项目的成本 针对利益攸关方(例如，其他公立医院)的RE-AIM框架的组成部分。该项目还将估计 从国家政策制定者的角度来看，捕捞相对于照常待遇的经济价值 合并：1)具有全国代表性的医疗补助单位医疗服务成本2)医疗补助报销数据 门诊护理服务，分发药品，以及随后在社区和 作为CATH干预总费用的一部分的门诊设置；以及3)额外的非医疗保健社会 支持利益攸关方作出比较评估和资源分配决定的安全网支出。