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Costs of implementing a multi-site facilitation intervention to increase access to medication treatment for opioid use disorder

BACKGROUND: The United States has been grappling with the opioid epidemic, which has resulted in over 75,000 opioid-related deaths between April 2020 and 2021. Evidence-based pharmaceutical interventions (buprenorphine, methadone, and naltrexone) are available to reduce opioid-related overdoses and...

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Autores principales: Garcia, Carla C., Bounthavong, Mark, Gordon, Adam J., Gustavson, Allison M., Kenny, Marie E., Miller, Wendy, Esmaeili, Aryan, Ackland, Princess E., Clothier, Barbara A., Bangerter, Ann, Noorbaloochi, Siamak, Harris, Alex H. S., Hagedorn, Hildi J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413546/
https://www.ncbi.nlm.nih.gov/pubmed/37563672
http://dx.doi.org/10.1186/s43058-023-00482-8
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author Garcia, Carla C.
Bounthavong, Mark
Gordon, Adam J.
Gustavson, Allison M.
Kenny, Marie E.
Miller, Wendy
Esmaeili, Aryan
Ackland, Princess E.
Clothier, Barbara A.
Bangerter, Ann
Noorbaloochi, Siamak
Harris, Alex H. S.
Hagedorn, Hildi J.
author_facet Garcia, Carla C.
Bounthavong, Mark
Gordon, Adam J.
Gustavson, Allison M.
Kenny, Marie E.
Miller, Wendy
Esmaeili, Aryan
Ackland, Princess E.
Clothier, Barbara A.
Bangerter, Ann
Noorbaloochi, Siamak
Harris, Alex H. S.
Hagedorn, Hildi J.
author_sort Garcia, Carla C.
collection PubMed
description BACKGROUND: The United States has been grappling with the opioid epidemic, which has resulted in over 75,000 opioid-related deaths between April 2020 and 2021. Evidence-based pharmaceutical interventions (buprenorphine, methadone, and naltrexone) are available to reduce opioid-related overdoses and deaths. However, adoption of these medications for opioid use disorder has been stifled due to individual- and system-level barriers. External facilitation is an evidence-based implementation intervention that has been used to increase access to medication for opioid use disorder (MOUD), but the implementation costs of external facilitation have not been assessed. We sought to measure the facility-level direct costs of implementing an external facilitation intervention for MOUD to provide decision makers with estimates of the resources needed to implement this evidence-based program. METHODS: We performed a cost analysis of the pre-implementation and implementation phases, including an itemization of external facilitation team and local site labor costs. We used labor estimates from the Bureau of Labor and Statistics, and sensitivity analyses were performed using labor estimates from the Veterans Health Administration (VHA) Financial Management System general ledger data. RESULTS: The average total costs for implementing an external facilitation intervention for MOUD per site was $18,847 (SD 6717) and ranged between $11,320 and $31,592. This translates to approximately $48 per patient with OUD. Sites with more encounters and participants with higher salaries in attendance had higher costs. This was driven mostly by the labor involved in planning and implementation activities. The average total cost of the pre-implementation and implementation activities were $1031 and $17,816 per site, respectively. In the sensitivity analysis, costs for VHA were higher than BLS estimates likely due to higher wages. CONCLUSIONS: Implementing external facilitation to increase MOUD prescribing may be affordable depending on the payer’s budget constraints. Our study reported that there were variations in the time invested at each phase of implementation and the number and type of participants involved with implementing an external facilitation intervention. Participant composition played an important role in total implementation costs, and decision makers will need to identify the most efficient and optimal number of stakeholders to involve in their implementation plans. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-023-00482-8.
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spelling pubmed-104135462023-08-11 Costs of implementing a multi-site facilitation intervention to increase access to medication treatment for opioid use disorder Garcia, Carla C. Bounthavong, Mark Gordon, Adam J. Gustavson, Allison M. Kenny, Marie E. Miller, Wendy Esmaeili, Aryan Ackland, Princess E. Clothier, Barbara A. Bangerter, Ann Noorbaloochi, Siamak Harris, Alex H. S. Hagedorn, Hildi J. Implement Sci Commun Research BACKGROUND: The United States has been grappling with the opioid epidemic, which has resulted in over 75,000 opioid-related deaths between April 2020 and 2021. Evidence-based pharmaceutical interventions (buprenorphine, methadone, and naltrexone) are available to reduce opioid-related overdoses and deaths. However, adoption of these medications for opioid use disorder has been stifled due to individual- and system-level barriers. External facilitation is an evidence-based implementation intervention that has been used to increase access to medication for opioid use disorder (MOUD), but the implementation costs of external facilitation have not been assessed. We sought to measure the facility-level direct costs of implementing an external facilitation intervention for MOUD to provide decision makers with estimates of the resources needed to implement this evidence-based program. METHODS: We performed a cost analysis of the pre-implementation and implementation phases, including an itemization of external facilitation team and local site labor costs. We used labor estimates from the Bureau of Labor and Statistics, and sensitivity analyses were performed using labor estimates from the Veterans Health Administration (VHA) Financial Management System general ledger data. RESULTS: The average total costs for implementing an external facilitation intervention for MOUD per site was $18,847 (SD 6717) and ranged between $11,320 and $31,592. This translates to approximately $48 per patient with OUD. Sites with more encounters and participants with higher salaries in attendance had higher costs. This was driven mostly by the labor involved in planning and implementation activities. The average total cost of the pre-implementation and implementation activities were $1031 and $17,816 per site, respectively. In the sensitivity analysis, costs for VHA were higher than BLS estimates likely due to higher wages. CONCLUSIONS: Implementing external facilitation to increase MOUD prescribing may be affordable depending on the payer’s budget constraints. Our study reported that there were variations in the time invested at each phase of implementation and the number and type of participants involved with implementing an external facilitation intervention. Participant composition played an important role in total implementation costs, and decision makers will need to identify the most efficient and optimal number of stakeholders to involve in their implementation plans. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-023-00482-8. BioMed Central 2023-08-10 /pmc/articles/PMC10413546/ /pubmed/37563672 http://dx.doi.org/10.1186/s43058-023-00482-8 Text en © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Garcia, Carla C.
Bounthavong, Mark
Gordon, Adam J.
Gustavson, Allison M.
Kenny, Marie E.
Miller, Wendy
Esmaeili, Aryan
Ackland, Princess E.
Clothier, Barbara A.
Bangerter, Ann
Noorbaloochi, Siamak
Harris, Alex H. S.
Hagedorn, Hildi J.
Costs of implementing a multi-site facilitation intervention to increase access to medication treatment for opioid use disorder
title Costs of implementing a multi-site facilitation intervention to increase access to medication treatment for opioid use disorder
title_full Costs of implementing a multi-site facilitation intervention to increase access to medication treatment for opioid use disorder
title_fullStr Costs of implementing a multi-site facilitation intervention to increase access to medication treatment for opioid use disorder
title_full_unstemmed Costs of implementing a multi-site facilitation intervention to increase access to medication treatment for opioid use disorder
title_short Costs of implementing a multi-site facilitation intervention to increase access to medication treatment for opioid use disorder
title_sort costs of implementing a multi-site facilitation intervention to increase access to medication treatment for opioid use disorder
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413546/
https://www.ncbi.nlm.nih.gov/pubmed/37563672
http://dx.doi.org/10.1186/s43058-023-00482-8
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