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.

项目概要 据估计，美国有 160 万人患有阿片类药物使用障碍 (OUD)，造成社会损失 787 美元 每年由于医疗保健支出和社会资源过剩而造成的损失达 10 亿美元。循证治疗 OUD 已被证明可以改善健康并降低医疗成本，但利用率仍然很低。 医院与住院患者成瘾咨询的模式以及与社区治疗的联系 排放已初步显示有效性；然而，人们对其经济价值或了解甚少 这种模式在公立医院环境中的可持续性。 2018年，提高放电后利用率 OUD 的循证药物治疗，纽约市健康与医院，最大的市立医院 美国的系统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，用于评估因阿片类药物相关住院的 OUD 患者， 当有需要时启动药物治疗，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 在增加治疗方面的作用 参与度、急症护理利用以及收集范围内的实施结果、有效性、 采用、实施和维护（RE-AIM）框架，应用最广泛的框架 衡量干预对现实世界环境的影响。该研究的经济部分重点 估计因急症护理利用率减少而导致的干预成本和潜在成本抵消 和过早死亡。然而，参与者群体主要由医疗补助受益人和 主要利益相关者将受益于扩大的经济信息（医疗补助支付的额外医疗保健、社会 由国家预算资助的安全网支出）以及评估 CATCH 在代表中的可行性的工具 环境。该项目将利用上述研究的研究基础设施来大幅提高 利益相关者，特别是那些主要负责的人可以获得的经济信息 代表研究人群（即政策制定者）​​做出治疗获取决定。该项目将 利用已收集的数据估算实施和维持 CATCH 干预所需的成本 父级研究的一部分，旨在构建可定制的预算影响工具，允许计算每个项目的成本 利益相关者（例如其他公立医院）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，CATCH 相对于常规治疗的经济价值 包括： 1) 具有全国代表性的医疗补助单位医疗服务成本 2) 医疗补助索赔数据 门诊护理服务、配药以及社区和社区中 OUD 的后续治疗 门诊设置作为 CATCH 干预总费用的一部分； 3) 额外的非医疗保健社会 支持利益攸关方的比较评估和资源分配决策的安全网支出。