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

项目摘要 据估计，美国有160万人患有阿片类药物使用障碍（OUD），社会成本为787美元。 10亿美元，这是由于过度的医疗保健支出和社会资源。循证治疗 OUD已被证明可以改善健康并降低医疗保健成本，但利用率仍然很低。 医院-住院戒毒咨询模式及与社区戒毒治疗的衔接 排放已初步证明有效;然而，对经济价值或 这些模式在公立医院环境中的可持续性。2018年，为提高出院后的利用率， OUD的循证药物治疗，纽约市健康与医院，最大的市立医院 在美国的成瘾治疗和护理系统中，引入了医院成瘾治疗和护理咨询（CATCH）干预措施。 CATCH是一种成瘾咨询模型，用于评估因OUD而接受阿片类药物相关住院治疗的个体， 在有指征时启动药物治疗，并直接将患者与出院后治疗联系起来。正在进行的 NIDA资助的混合有效性实施试验正在评估CATCH增加治疗的效果 参与，急性护理利用，并收集范围内的实施结果，有效性， 采用、实施和维护（RE-AIM）框架，是应用最广泛的 衡量干预措施在真实的世界环境中的影响。该研究的经济部分侧重于 估计急性护理利用率降低导致的干预成本和潜在成本抵消 和过早死亡。然而，参与人口主要由医疗补助受益人组成， 主要利益相关者将受益于扩大的经济信息（由医疗补助支付的额外医疗保健，社会 通过国家预算提供资金的安全网支出）和评估CATCH在有代表性的 设置.该项目将利用上述研究的研究基础设施， 利益相关者可获得的经济信息，特别是那些主要负责 代表研究人群做出治疗准入决定，即，政策制定者。该项目将 利用已收集的数据估算实施和维持CATCH干预措施所需的成本， 家长研究的一部分，以建立一个可定制的预算影响工具，允许成本计算为每个 RE-AIM框架的利益相关者组成部分（例如，其他公立医院）。该项目还将估计 从州决策者的角度来看，CATCH相对于常规治疗的经济价值， 合并：1）医疗服务的全国代表性医疗补助单位成本2）医疗补助索赔数据， 门诊护理服务，分发药物，并在社区进行OUD后续治疗， 门诊设置作为CATCH干预总成本的一部分;和3）额外的非医疗保健社会 安全网支出，以支持利益攸关方的比较评估和资源分配决定。

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.