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

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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.