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Bowser D, McCollister K, Berchtold G, Ruscitti B, Yang Y, Hines H, Fardone E, Knight D. Start-Up and Implementation Costs for the Trust Based Relational Intervention. JOURNAL OF PREVENTION (2022) 2024:10.1007/s10935-024-00803-0. [PMID: 39153158 DOI: 10.1007/s10935-024-00803-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 08/19/2024]
Abstract
Capturing costs associated with prevention activities related to substance use disorders (SUD) and mental health (MH) is critical. In this study, Trust Based Relational Intervention (TBRI®), an attachment-based, trauma-informed intervention, is conceptualized as a preventive intervention to reduce substance and opioid use among youth involved with the legal system. When implemented alongside community reentry, TBRI leverages family systems as youth transition from secure residential care into communities through emotional guidance and role modeling. Activity-based cost (ABC) analysis was used to guide cost data collection and analysis for both start-up and implementation of the TBRI intervention. Start-up costs were estimated using data across eight sites during their start-up phase. All components, activities, personnel involved, and time associated with implementation of TBRI sessions according to protocol were defined. National wages were extracted from O*NET and utilized to calculate total costs for each TBRI component. Total and average TBRI intervention costs were calculated with a breakdown by TBRI sessions and number of staff and participants. A sensitivity analysis was conducted to estimate TBRI implementation costs with travel. The total cost for the TBRI intervention, representing 42 sessions, ranges from $6,927, without travel expenses or $12,298, with travel expenses. The average per family cost ranges from $1,385 (without travel) to $2,460 (with travel). Costs are primarily generated by time investments from primary interventionists. The sensitivity analysis shows costs for responsive coaching would double with travel costs included. Results aim to show that using ABC for prevention activities, like TBRI, to understand cost drivers can facilitate future intervention sustainability.Clinical Trail.gov ID: NCT04678960.
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Affiliation(s)
- Diana Bowser
- Connell School of Nursing, Boston College, 140 Commonwealth Ave., Chestnut Hill, MA, 0467, USA.
| | - Kathryn McCollister
- Miller School of Medicine, University of Miami, 1400 NW 12th Ave, Miami, FL, 33125, USA
| | - Grace Berchtold
- Heller School for Social Policy and Management, Brandeis University, 415 South St., Waltham, MA, 02453, USA
| | - Brielle Ruscitti
- Connell School of Nursing, Boston College, 140 Commonwealth Ave., Chestnut Hill, MA, 0467, USA
| | - Yang Yang
- Institute of Behavioral Research, Texas Christian University, 3034 Sandage Ave, Fort Worth, TX, 76109, USA
| | - Heather Hines
- Institute of Behavioral Research, Texas Christian University, 3034 Sandage Ave, Fort Worth, TX, 76109, USA
| | - Erminia Fardone
- Miller School of Medicine, University of Miami, 1400 NW 12th Ave, Miami, FL, 33125, USA
| | - Danica Knight
- Miller School of Medicine, University of Miami, 1400 NW 12th Ave, Miami, FL, 33125, USA
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Krawczyk N, Lim S, Cherian T, Goldfeld KS, Katyal M, Rivera BD, McDonald R, Khan M, Wiewel E, Braunstein S, Murphy SM, Jalali A, Jeng PJ, Kutscher E, Khatri UG, Rosner Z, Vail WL, MacDonald R, Lee JD. Transitions of care between jail-based medications for opioid use disorder and ongoing treatment in the community: A retrospective cohort study. Drug Alcohol Depend 2024; 261:111377. [PMID: 38924958 PMCID: PMC11249039 DOI: 10.1016/j.drugalcdep.2024.111377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/17/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Offering medications for opioid use disorder (MOUD) in carceral settings significantly reduces overdose. However, it is unknown to what extent individuals in jails continue MOUD once they leave incarceration. We aimed to assess the relationship between in-jail MOUD and MOUD continuity in the month following release. METHODS We conducted a retrospective cohort study of linked NYC jail-based electronic health records and community Medicaid OUD treatment claims for individuals with OUD discharged from jail between 2011 and 2017. We compared receipt of MOUD within 30 days of release, among those with and without MOUD at release from jail. We tested for effect modification based on MOUD receipt prior to incarceration and assessed factors associated with treatment discontinuation. RESULTS Of 28,298 eligible incarcerations, 52.8 % received MOUD at release. 30 % of incarcerations with MOUD at release received community-based MOUD within 30 days, compared to 7 % of incarcerations without MOUD (Risk Ratio: 2.62 (2.44-2.82)). Most (69 %) with MOUD claims prior to incarceration who received in-jail MOUD continued treatment in the community, compared to 9 % of those without prior MOUD. Those who received methadone (vs. buprenorphine), were younger, Non-Hispanic Black and with no history of MOUD were less likely to continue MOUD following release. CONCLUSIONS MOUD maintenance in jail is strongly associated with MOUD continuity upon release. Still, findings highlight a gap in treatment continuity upon-reentry, especially among those who initiate MOUD in jail. In the wake of worsening overdose deaths and troubling disparities, improving MOUD continuity among this population remains an urgent priority.
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Affiliation(s)
- Noa Krawczyk
- NYU Grossman School of Medicine, Departments of Population Health and Medicine, 180 Madison Ave, New York, NY, United States.
| | - Sungwoo Lim
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY, United States
| | - Teena Cherian
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY, United States
| | - Keith S Goldfeld
- NYU Grossman School of Medicine, Departments of Population Health and Medicine, 180 Madison Ave, New York, NY, United States
| | - Monica Katyal
- NYC Health + Hospitals, Correctional Health Services, 55 Water Street, 18th Floor, New York, NY, United States
| | - Bianca D Rivera
- NYU Grossman School of Medicine, Departments of Population Health and Medicine, 180 Madison Ave, New York, NY, United States
| | - Ryan McDonald
- NYU Grossman School of Medicine, Departments of Population Health and Medicine, 180 Madison Ave, New York, NY, United States
| | - Maria Khan
- NYU Grossman School of Medicine, Departments of Population Health and Medicine, 180 Madison Ave, New York, NY, United States
| | - Ellen Wiewel
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY, United States
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY, United States
| | - Sean M Murphy
- Weill Cornell Medical College, Department of Population Health Sciences, New York, NY, United States
| | - Ali Jalali
- Weill Cornell Medical College, Department of Population Health Sciences, New York, NY, United States
| | - Philip J Jeng
- Weill Cornell Medical College, Department of Population Health Sciences, New York, NY, United States
| | - Eric Kutscher
- NYU Grossman School of Medicine, Departments of Population Health and Medicine, 180 Madison Ave, New York, NY, United States; Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, 1 Gustav L. Levy Pl, NY, United States
| | - Utsha G Khatri
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, 1 Gustav L. Levy Pl, NY, United States
| | - Zachary Rosner
- NYC Health + Hospitals, Correctional Health Services, 55 Water Street, 18th Floor, New York, NY, United States
| | - William L Vail
- NYC Health + Hospitals, Correctional Health Services, 55 Water Street, 18th Floor, New York, NY, United States
| | - Ross MacDonald
- NYU Grossman School of Medicine, Departments of Population Health and Medicine, 180 Madison Ave, New York, NY, United States; NYC Health + Hospitals, Correctional Health Services, 55 Water Street, 18th Floor, New York, NY, United States
| | - Joshua D Lee
- NYU Grossman School of Medicine, Departments of Population Health and Medicine, 180 Madison Ave, New York, NY, United States
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Jalali A. Informing evidence-based medicine for opioid use disorder using pharmacoeconomic studies. Expert Rev Pharmacoecon Outcomes Res 2024; 24:599-611. [PMID: 38696161 DOI: 10.1080/14737167.2024.2350561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION The health and economic consequences of inadequately treated opioid use disorder (OUD) are substantial. Healthcare systems in the United States (US) and other countries are facing a growing healthcare crisis due to opioids. Although effective medications for OUD exist, relying solely on clinical information is insufficient for addressing the opioid crisis. AREAS COVERED In this review, the role of pharmacoeconomic studies in informing evidence-based medication treatment for OUD is discussed, with a particular emphasis on the US healthcare system, where the economic burden is significantly higher than the global average. The scope/objective of pharmacoeconomics as a distinct scientific research program is briefly defined, followed by a discussion of existing evidence informed by data from systematic reviews, in addition to a convenience sample of recently published pharmacoeconomic studies and protocols. The review also explores the need for methodological advancements in the field. EXPERT OPINION Despite the potential of pharmacoeconomic research in shaping evidence-based medicine for OUD, significant challenges limiting its real-world application remain. How to address these challenges are explored, including how to combine cost-effectiveness and budget impact analyses to address the needs of the healthcare system as a whole and specific stakeholders interested in adopting new OUD treatment strategies.
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Affiliation(s)
- Ali Jalali
- Department of Population Health Sciences, Division of Comparative Effectiveness & Outcomes Research, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
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Lim S, Cherian T, Katyal M, Goldfeld KS, McDonald R, Wiewel E, Khan M, Krawczyk N, Braunstein S, Murphy SM, Jalali A, Jeng PJ, Rosner Z, MacDonald R, Lee JD. Jail-based medication for opioid use disorder and patterns of reincarceration and acute care use after release: A sequence analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209254. [PMID: 38072387 PMCID: PMC10947890 DOI: 10.1016/j.josat.2023.209254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/25/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Treatment with methadone and buprenorphine medications for opioid use disorder (MOUD) during incarceration may lead to better community re-entry, but evidence on these relationships have been mixed. We aimed to identify community re-entry patterns and examine the association between in-jail MOUD and a pattern of successful reentry defined by rare occurrence of reincarceration and preventable healthcare utilization. METHODS Data came from a retrospective, observational cohort study of 6066 adults with opioid use disorder who were incarcerated in New York City jails and released to the community during 2011-14. An outcome was community re-entry patterns identified by sequence analysis of 3-year post-release reincarceration, emergency department visits, and hospitalizations. An exposure was receipt of in-jail MOUD versus out-of-treatment (42 % vs. 58 %) for the last 3 days before discharge. The study accounted for differences in baseline demographic, clinical, behavioral, housing, and criminal legal characteristics between in-jail MOUD and out-of-treatment groups via propensity score matching. RESULTS This study identified five re-entry patterns: stability (64 %), hospitalization (23 %), delayed reincarceration (7 %), immediate reincarceration (4 %), and continuous incarceration (2 %). After addressing confounding, 64 % and 57 % followed the stability pattern among MOUD and out-of-treatment groups who were released from jail in 2011, respectively. In 2012-14, the prevalence of following the stability pattern increased year-by-year while a consistently higher prevalence was observed among those with in-jail MOUD. CONCLUSIONS Sequence analysis helped define post-release stability based on health and criminal legal system involvement. Receipt of in-jail MOUD was associated with a marker of successful community re-entry.
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Affiliation(s)
- Sungwoo Lim
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America.
| | - Teena Cherian
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America
| | - Monica Katyal
- NYC Health and Hospitals/Correctional Health Services, New York, NY, United States of America
| | - Keith S Goldfeld
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Ryan McDonald
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Ellen Wiewel
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America
| | - Maria Khan
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Noa Krawczyk
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America
| | - Sean M Murphy
- Weill Cornell Medical College, New York, NY, United States of America
| | - Ali Jalali
- Weill Cornell Medical College, New York, NY, United States of America
| | - Philip J Jeng
- Weill Cornell Medical College, New York, NY, United States of America
| | - Zachary Rosner
- NYC Health and Hospitals/Correctional Health Services, New York, NY, United States of America
| | - Ross MacDonald
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Joshua D Lee
- New York University Grossman School of Medicine, New York, NY, United States of America
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Abstract
This paper is the forty-fifth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2022 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, USA.
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Cadet T, Jalali A, Jeng PJ, Poole S, Woody G, Murphy SM. Determinants of health-related quality of life among individuals with opioid use disorder, recently released from incarceration. Addict Sci Clin Pract 2023; 18:34. [PMID: 37231479 DOI: 10.1186/s13722-023-00375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND\OBJECTIVES: Concomitant with low rates of pharmacotherapy for incarcerated individuals with OUD, there is a high rate of opioid overdose following re-entry into the community. Our research objective was to develop a better understanding of the factors that influence health-related quality-of-life (HRQoL) among this population during the high-risk transition period from incarceration to community. Few studies have assessed health-related quality-of-life (HRQoL) among individuals with OUD who are involved with the criminal-legal system, let alone over the period directly surrounding release from incarceration. METHODS Secondary longitudinal analysis of data from a clinical trial where participants were randomized 1:1 to pre-release extended-release naltrexone (XR-NTX) + referral to community XR-NTX, vs. referral only. We conducted individual, multivariable regressions of EQ-5D domains (mobility, pain/discomfort, anxiety/depression; usual activities and self-care were excluded due to insufficient variation in scores), and the overall preference/utility score. HRQoL data were subset to timepoints immediately before release (baseline) and 12 weeks post-release; treatment groups were collapsed across condition. Multiple imputation by chained equations was conducted to handle missing 3-month data in the dependent variables and covariates, ad hoc. RESULTS Greater severity in the psychiatric composite score was associated with substantially lower HRQoL, across all measures, following release from incarceration. Greater severity in the medical composite score was associated with lower pain/discomfort-related HRQoL. CONCLUSIONS Our findings highlight the importance of ensuring individuals with OUD are linked not only to MOUD, but also treatment for their comorbid conditions upon release from incarceration.
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Affiliation(s)
- Techna Cadet
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, Suite 301, New York, NY, 10065, USA.
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, Suite 301, New York, NY, 10065, USA
| | - Philip J Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, Suite 301, New York, NY, 10065, USA
| | - Sabrina Poole
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - George Woody
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, Suite 301, New York, NY, 10065, USA
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