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Dunlap LJ, Orme S, Zarkin GA, Holtgrave DR, Maulsby C, Rodewald AM, Holtyn AF, Silverman K. Correction to: Cost and Cost‑Effectiveness of Incentives for Viral Suppression in People Living with HIV. AIDS Behav 2024:10.1007/s10461-024-04265-7. [PMID: 38340223 DOI: 10.1007/s10461-024-04265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Affiliation(s)
- Laura J Dunlap
- Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - Stephen Orme
- Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA.
- RTI International, 701 13 Street NW, Suite 750, Washington, DC, 20005‑3967, USA.
| | - Gary A Zarkin
- Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - David R Holtgrave
- School of Public Health, and Center for Collaborative HIV Research in Practice and Policy, State University of New York, Albany, NY, USA
| | - Catherine Maulsby
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew M Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Dever JA, Hertz MF, Dunlap LJ, Richardson JS, Wolicki SB, Biggers BB, Edlund MJ, Bohm MK, Turcios D, Jiang X, Zhou H, Evans ME, Guy GP. The Medications for Opioid Use Disorder Study: Methods and Initial Outcomes From an 18-Month Study of Patients in Treatment for Opioid Use Disorder. Public Health Rep 2024:333549231222479. [PMID: 38268479 DOI: 10.1177/00333549231222479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE Opioid use disorder (OUD) affects approximately 5.6 million people in the United States annually, yet rates of the use of effective medication for OUD (MOUD) treatment are low. We conducted an observational cohort study from August 2017 through May 2021, the MOUD Study, to better understand treatment engagement and factors that may influence treatment experiences and outcomes. In this article, we describe the study design, data collected, and treatment outcomes. METHODS We recruited adult patients receiving OUD treatment at US outpatient facilities for the MOUD Study. We collected patient-level data at 5 time points (baseline to 18 months) via self-administered questionnaires and health record data. We collected facility-level data via questionnaires administered to facility directors at 2 time points. Across 16 states, 62 OUD treatment facilities participated, and 1974 patients enrolled in the study. We summarized descriptive data on the characteristics of patients and OUD treatment facilities and selected treatment outcomes. RESULTS Approximately half of the 62 facilities were private, nonprofit organizations; 62% focused primarily on substance use treatment; and 20% also offered mental health services. Most participants were receiving methadone (61%) or buprenorphine (32%) and were predominately non-Hispanic White (68%), aged 25-44 years (62%), and female (54%). Compared with patient-reported estimates at baseline, 18-month estimates suggested that rates of abstinence increased (55% to 77%), and rates of opioid-related overdoses (7% to 2%), emergency department visits (9% to 4%), and arrests (15% to 7%) decreased. CONCLUSIONS Our results demonstrated the benefits of treatment retention not only on abstinence from opioid use but also on other quality-of-life metrics, with data collected during an extended period. The MOUD Study produced rich, multilevel data that can lay the foundation for an evidence base to inform OUD treatment and support improvement of care and patient outcomes.
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Affiliation(s)
| | - Marci F Hertz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - John S Richardson
- RTI International, Research Triangle Park, NC, USA
- Current affiliation: Stop Soldier Suicide, Durham, NC, USA
| | | | | | | | - Michele K Bohm
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Xinyi Jiang
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hong Zhou
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary E Evans
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gery P Guy
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Zarkin GA, Orme S, Dunlap LJ, Kelly SM, Mitchell SG, O'Grady KE, Schwartz RP. Corrigendum to "Cost and cost-effectiveness of interim methadone treatment and patient navigation initiated in jail" [Drug Alcohol Depend. 217 (2020) 108292]. Drug Alcohol Depend 2024; 254:110913. [PMID: 37580212 PMCID: PMC10843802 DOI: 10.1016/j.drugalcdep.2023.110913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Gary A Zarkin
- RTI, International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park,NC 27709-2194,United States
| | - Stephen Orme
- RTI, International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park,NC 27709-2194,United States.
| | - Laura J Dunlap
- RTI, International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park,NC 27709-2194,United States
| | - Sharon M Kelly
- Friends Research Institute, 1040 Park Avenue Suite 103,Baltimore,MD 21201,United States
| | - Shannon G Mitchell
- Friends Research Institute, 1040 Park Avenue Suite 103,Baltimore,MD 21201,United States
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, 4094 Campus Drive,College Park,MD 20742,United States
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue Suite 103,Baltimore,MD 21201,United States
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Orme S, Zarkin GA, Luckey J, Dunlap LJ, Novak MD, Holtyn AF, Toegel F, Silverman K. Corrigendum to "Cost and cost-effectiveness of abstinence contingent wage supplements" [Drug Alcohol Depend. 244 (2023) 109754]. Drug Alcohol Depend 2024; 254:110914. [PMID: 37612157 PMCID: PMC10843612 DOI: 10.1016/j.drugalcdep.2023.110914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Stephen Orme
- RTI International, Research Triangle Park, NC, United States.
| | - Gary A Zarkin
- RTI International, Research Triangle Park, NC, United States
| | - Jackson Luckey
- RTI International, Research Triangle Park, NC, United States
| | - Laura J Dunlap
- RTI International, Research Triangle Park, NC, United States
| | - Matthew D Novak
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - August F Holtyn
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Forrest Toegel
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kenneth Silverman
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Orme S, Zarkin GA, Dunlap LJ, Monico LB, Gryczynski J, Fishman MJ, Schwartz RP, O'Grady KE, Mitchell SG. Health care use and cost of treatment for adolescents and young adults with opioid use disorder. J Subst Use Addict Treat 2023; 154:209137. [PMID: 37558183 PMCID: PMC10687977 DOI: 10.1016/j.josat.2023.209137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Few studies have examined the cost of medication for opioid use disorder (MOUD) with counseling for the adolescent and young adult population. This study calculated the health care utilization and cost of MOUD treatment, other substance use disorder treatment, and general health care for adolescents and young adults receiving treatment for opioid use disorder. METHODS The study randomized youth ages 15 to 21 (N = 288) equally into the two study conditions: extended-release naltrexone (XR-NTX) or treatment as usual (TAU). While participants committed to treatment based on randomization the study observed considerable nonadherence to both randomized conditions. Instead of using the randomly assigned study conditions, we present descriptive costs by the type of MOUD treatment received: XR-NTX only, buprenorphine only, any other combination of MOUD treatments, and no MOUD. Health care use was aggregated over the 6-month period for each participant, and we calculated average/participant utilization for each treatment group. To determine participant costs, we multiplied the unit costs of health care services obtained from the literature by the reported amount of health care utilization for each participant. We then calculated the mean, standard error, median and IQR for MOUD costs, other substance use disorder treatment costs and general healthcare cost from the health care sector perspective. RESULTS On average, participants in the XR-NTX only group received 2.6 doses of XR-NTX (equivalent to approximately 78 days of treatment). The buprenorphine only group had an average of 97 days of buprenorphine treatment. The XR-NTX only group had higher/patient costs compared to participants in the buprenorphine only group ($10,491 vs. $8765) and higher XR-NTX utilization would further increase costs. Participants in the any other MOUD combination group had the highest total costs ($14,627) while participants in the no MOUD group at the lowest ($3453). DISCUSSION Our cost analysis calculates the real-world cost of MOUD treatment and, while not generalizable, provides policy makers an estimate of costs for adolescents and young adults. We found that participants in the XR-NTX only group received fewer days of medication compared to the buprenorphine only group, but their medication costs were higher due to the cost of XR-NTX injections. While the buprenorphine only group had the highest number of days of medication utilization of all the groups, the average number of days of medication utilization was considerably shorter than the six-month treatment period.
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Affiliation(s)
- Stephen Orme
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA.
| | - Gary A Zarkin
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA
| | - Laura J Dunlap
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA
| | - Laura B Monico
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA
| | - Marc J Fishman
- Mountain Manor Treatment Center, 3800 Frederick Avenue, Baltimore 21229, MD, USA
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
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Dunlap LJ, Kuklinski MR, Cowell A, McCollister KE, Bowser DM, Campbell M, Fernandes CSF, Kemburu P, Livingston BJ, Prosser LA, Rao V, Smart R, Yilmazer T. Economic Evaluation Design within the HEAL Prevention Cooperative. Prev Sci 2023; 24:50-60. [PMID: 35947282 PMCID: PMC9364296 DOI: 10.1007/s11121-022-01400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/01/2022]
Abstract
The rapid rise in opioid misuse, disorder, and opioid-involved deaths among older adolescents and young adults is an urgent public health problem. Prevention is a vital part of the nation's response to the opioid crisis, yet preventive interventions for those at risk for opioid misuse and opioid use disorder are scarce. In 2019, the National Institutes of Health (NIH) launched the Preventing Opioid Use Disorder in Older Adolescents and Young Adults cooperative as part of its broader Helping to End Addiction Long-term (HEAL) Initiative ( https://heal.nih.gov/ ). The HEAL Prevention Cooperative (HPC) includes ten research projects funded with the goal of developing effective prevention interventions across various settings (e.g., community, health care, juvenile justice, school) for older adolescent and young adults at risk for opioid misuse and opioid use disorder (OUD). An important component of the HPC is the inclusion of an economic evaluation by nine of these research projects that will provide information on the costs, cost-effectiveness, and sustainability of these interventions. The HPC economic evaluation is integrated into each research project's overall design with start-up costs and ongoing delivery costs collected prospectively using an activity-based costing approach. The primary objectives of the economic evaluation are to estimate the intervention implementation costs to providers, estimate the cost-effectiveness of each intervention for reducing opioid misuse initiation and escalation among youth, and use simulation modeling to estimate the budget impact of broader implementation of the interventions within the various settings over multiple years. The HPC offers an extraordinary opportunity to generate economic evidence for substance use prevention programming, providing policy makers and providers with critical information on the investments needed to start-up prevention interventions, as well as the cost-effectiveness of these interventions relative to alternatives. These data will help demonstrate the valuable role that prevention can play in combating the opioid crisis.
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Affiliation(s)
- Laura J Dunlap
- RTI International, E. Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | | | - Alexander Cowell
- The University of North Carolina at Chapel Hill, School of Government of Chapel Hill, NC, USA
| | - Kathryn E McCollister
- Soffer Clinical Research Center, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diana M Bowser
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | | | - Pranav Kemburu
- RTI International, E. Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | | | - Lisa A Prosser
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Tansel Yilmazer
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
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Orme S, Zarkin GA, Luckey J, Dunlap LJ, Novak MD, Holtyn AF, Toegel F, Silverman K. Cost and cost-effectiveness of abstinence contingent wage supplements. Drug Alcohol Depend 2023; 244:109754. [PMID: 36638680 PMCID: PMC10207811 DOI: 10.1016/j.drugalcdep.2022.109754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Substance use disorders are correlated with unemployment and poverty. However, few interventions aim to improve substance use, unemployment, and, distally, poverty. The Abstinence-Contingent Wage Supplement (ACWS) randomized controlled trial combined a therapeutic workplace with abstinence-contingent wage supplements to address substance use and unemployment. The ACWS study found that abstinence-contingent wage supplements increased the percentage of participants who had negative drug tests, who were employed, and who were above the poverty line during the intervention period. This study presents the cost of ACWS and calculates the cost-effectiveness of ACWS compared with usual care. METHODS To calculate the cost and cost-effectiveness of ACWS, we used activity-based costing methods to cost the intervention and calculated the costs from the provider and healthcare sector perspective. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves for negative drug tests and employment. RESULTS ACWS cost $11,310 per participant over the 12-month intervention period. Total intervention and healthcare costs per participant over the intervention period were $20,625 for usual care and $30,686 for ACWS. At the end of the intervention period an additional participant with a negative drug test cost $1437 while an additional participant employed cost $915. CONCLUSIONS ACWS increases drug abstinence and employment and may be cost-effective at the end of the 12-month intervention period if decision makers are willing to pay the incremental cost associated with the intervention.
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Affiliation(s)
- Stephen Orme
- RTI International, Research Triangle Park, NC, United States.
| | - Gary A Zarkin
- RTI International, Research Triangle Park, NC, United States
| | - Jackson Luckey
- RTI International, Research Triangle Park, NC, United States
| | - Laura J Dunlap
- RTI International, Research Triangle Park, NC, United States
| | - Matthew D Novak
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - August F Holtyn
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Forrest Toegel
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kenneth Silverman
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Orme S, Zarkin GA, Dunlap LJ, Nordeck CD, Schwartz RP, Mitchell SG, Welsh C, O’Grady KE, Gryczynski J. Cost and Cost Savings of Navigation Services to Avoid Rehospitalization for a Comorbid Substance Use Disorder Population. Med Care 2022; 60:631-635. [PMID: 35687900 PMCID: PMC9382857 DOI: 10.1097/mlr.0000000000001743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A randomized clinical trial found that patient navigation for hospital patients with comorbid substance use disorders (SUDs) reduced emergency department (ED) and inpatient hospital utilization compared with treatment-as-usual. OBJECTIVE To compare the cost and calculate any cost savings from the Navigation Services to Avoid Rehospitalization (NavSTAR) intervention over treatment-as-usual. RESEARCH DESIGN This study calculates activity-based costs from the health care providers and uses a net benefits approach to calculate the cost savings generated from NavSTAR. NavSTAR provided patient navigation focused on engagement in SUD treatment, starting before hospital discharge and continuing for up to 3 months postdischarge. SUBJECTS Adult hospitalized medical/surgical patients with comorbid SUD for opioids, cocaine, and/or alcohol. COST MEASURES Cost of the 3-month NavSTAR patient navigation intervention and the cost of all inpatient days and ED visits over a 12-month period. RESULTS OF BASE CASE ANALYSIS NavSTAR generated $17,780 per participant in cost savings. Ninety-seven percent of bootstrapped samples generated positive cost savings, and our sensitivity analyses did not change our results. LIMITATIONS Participants were recruited at one hospital in Baltimore, MD through the hospital's addiction consultation service. Findings may not generalize to the broader population. Outpatient health care cost data was not available through administrative records. CONCLUSION Our findings show that patient navigation interventions should be considered by payors and policy makers to reduce the high hospital costs associated with comorbid SUD patients.
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Affiliation(s)
- Stephen Orme
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709
| | - Gary A. Zarkin
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709
| | - Laura J. Dunlap
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709
| | | | - Robert P. Schwartz
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201
| | | | - Christopher Welsh
- University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201
| | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, College Park, 4094 Campus Drive, College Park, MD 20742
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201
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Dunlap LJ, Orme S, Zarkin GA, Holtgrave DR, Maulsby C, Rodewald AM, Holtyn AF, Silverman K. Cost and Cost-Effectiveness of Incentives for Viral Suppression in People Living with HIV. AIDS Behav 2022; 26:795-804. [PMID: 34436714 DOI: 10.1007/s10461-021-03439-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
Only 63% of people living with HIV in the United States are achieving viral suppression. Structural and social barriers limit adherence to antiretroviral therapy which furthers the HIV epidemic while increasing health care costs. This study calculated the cost and cost-effectiveness of a contingency management intervention with cash incentives. People with HIV and detectable viral loads were randomized to usual care or an incentive group. Individuals could earn up to $3650 per year if they achieved and maintained an undetectable viral load. The average 1-year intervention cost, including incentives, was $4105 per patient. The average health care costs were $27,189 per patient in usual care and $35,853 per patient in the incentive group. We estimated a cost of $28,888 per quality-adjusted life-year (QALY) gained, which is well below accepted cost-per-QALY thresholds. Contingency management with cash incentives is a cost-effective intervention for significantly increasing viral suppression.
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Affiliation(s)
- Laura J Dunlap
- Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - Stephen Orme
- Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA.
- RTI International, 701 13th Street NW, Suite 750, Washington, DC, 20005-3967, USA.
| | - Gary A Zarkin
- Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - David R Holtgrave
- School of Public Health, and Center for Collaborative HIV Research in Practice and Policy, State University of New York, Albany, NY, USA
| | - Catherine Maulsby
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew M Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Dunlap LJ, Jaccard J, Lackner JM. Minimal-Contact Versus Standard Cognitive Behavioral Therapy for Irritable Bowel Syndrome: Cost-Effectiveness Results of a Multisite Trial. Ann Behav Med 2021; 55:981-993. [PMID: 33821928 DOI: 10.1093/abm/kaaa119] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common, often disabling gastrointestinal (GI) disorder for which there is no satisfactory medical treatment but is responsive to cognitive behavior therapy (CBT). PURPOSE To evaluate the costs and cost-effectiveness of a minimal contact version of CBT (MC-CBT) condition for N = 145 for IBS relative to a standard, clinic-based CBT (S-CBT; N = 146) and a nonspecific comparator emphasizing education/support (EDU; N = 145). METHOD We estimated the per-patient cost of each treatment condition using an activity-based costing approach that allowed us to identify and estimate costs for specific components of each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of MC-CBT relative to S-CBT and EDU. We then evaluated the cost-effectiveness of MC-CBT relative to these alternatives for selected outcomes at immediate posttreatment and 6 months posttreatment, using both an intent-to-treatment and per-protocol methodology. Key outcomes included scores on the Clinical Global Impressions-Improvement Scale and the percentage of patients who positively responded to treatment. RESULTS The average per-patient cost of delivering MC-CBT was $348, which was significantly less than the cost of S-CBT ($644) and EDU ($457) (p < .01). Furthermore, MC-CBT produced better average patient outcomes at immediate and 6 months posttreatment relative to S-CBT and EDU (p < .01). The current findings indicated that MC-CBT is a cost-effective option relative to S-CBT and EDU. CONCLUSION As predicted, MC-CBT was delivered at a lower cost per patient than S-CBT and performed better over time on the primary outcome of global IBS symptom improvement.
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Affiliation(s)
| | - James Jaccard
- Silver School of Social Work, New York University, 1 Washington Square North New York, New York, USA
| | - Jeffrey M Lackner
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, SUNY, ECMC, Buffalo, NY, USA
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Zarkin GA, Orme S, Dunlap LJ, Kelly SM, Mitchell SG, O'Grady KE, Schwartz RP. Cost and cost-effectiveness of interim methadone treatment and patient navigation initiated in jail. Drug Alcohol Depend 2020; 217:108292. [PMID: 32992151 PMCID: PMC7736121 DOI: 10.1016/j.drugalcdep.2020.108292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals with opioid use disorder (OUD) who are released from pre-trial detention in jail have a high risk of opioid relapse. While several interventions for OUD initiated during incarceration have been studied, few have had an economic evaluation. As part of a three-group randomized trial, we estimated the cost and cost-effectiveness of a negative urine opioid test. Detainees were assigned to interim methadone (IM) in jail with continued methadone treatment post-release with and without 3 months of post-release patient navigation (PN) compared to an enhanced treatment-as-usual group. METHODS We implemented a micro-costing approach from the provider's perspective to estimate the cost per participant in jail and over the 12 months post-release from jail. Economic data included jail-based and community-based service utilization, self-reported healthcare utilization and justice system involvement, and administrative arrest records. Our outcome measure is the number of participants with a negative opioid urine test at their 12-month follow-up. We calculated incremental cost-effectiveness ratios (ICERs) for intervention costs only and costs from a societal perspective. RESULTS The average cost of providing patient navigation services per individual beginning in jail and continuing in the community was $283. We find that IM is dominated by ETAU and IM + PN. Per additional participant with a negative opioid urine test, the ICER for IM + PN including intervention costs only is $91 and $305 including societal costs. CONCLUSIONS IM + PN is almost certainly the cost-effective choice from both an intervention provider and societal perspective.
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Affiliation(s)
- Gary A Zarkin
- RTI, International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States
| | - Stephen Orme
- RTI, International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States.
| | - Laura J Dunlap
- RTI, International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States
| | - Sharon M Kelly
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201, United States
| | - Shannon G Mitchell
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201, United States
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, 4094 Campus Drive, College Park, MD 20742, United States
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201, United States
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Dunlap LJ, O'Farrell TJ, Schumm JA, Orme SS, Murphy M, Murchowski PM. Group Versus Standard Behavioral Couples' Therapy for Alcohol Use Disorder Patients: Cost-Effectiveness. J Stud Alcohol Drugs 2020. [PMID: 32359044 DOI: 10.15288/jsad.2020.81.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the costs and cost-effectiveness of two treatments for 101 alcohol use disorder patients and their intimate partners--group behavioral couples' therapy plus individual-based treatment (G-BCT), or standard behavioral couples' therapy plus individual-based treatment (S-BCT). METHOD We estimated the per-patient cost of each intervention using a microcosting approach that allowed us to estimate costs of specific components in each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of G-BCT relative to S-BCT. Immediately after treatment and 12 months after treatment, we computed incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves for percentage days abstinent, adverse consequences of alcohol and drugs, and overall relationship functioning. RESULTS The average per-patient cost of delivering G-BCT was $674, significantly less than the cost of S-BCT ($831). However, 12 months after treatment, S-BCT participants performed better on all outcomes compared with those in G-BCT, and the calculated ICER moving from G-BCT to S-BCT ranged from $10 to $12 across these outcomes. The current findings indicated that, except at very low willingness-to-pay values, S-BCT is a cost-effective option relative to G-BCT when considering 12-month posttreatment outcomes. CONCLUSIONS As expected, G-BCT was delivered at a lower cost per patient than S-BCT; however, S-BCT performed better over time on the clinical outcomes studied. These economic findings indicate that alcohol use disorder treatment providers should seriously consider S-BCT over G-BCT when deciding what format to use in behavioral couples' therapy.
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Affiliation(s)
- Laura J Dunlap
- RTI International, Research Triangle Park, North Carolina
| | - Timothy J O'Farrell
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts.,Harvard Medical School Department of Psychiatry, Boston, Massachusetts
| | - Jeremiah A Schumm
- School of Professional Psychology, Wright State University, Ellis Human Development Institute, Dayton, Ohio
| | | | - Marie Murphy
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts.,Harvard Medical School Department of Psychiatry, Boston, Massachusetts
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Dunlap LJ, O’Farrell TJ, Schumm JA, Orme SS, Murphy M, Murchowski PM. Group Versus Standard Behavioral Couples' Therapy for Alcohol Use Disorder Patients: Cost-Effectiveness. J Stud Alcohol Drugs 2020; 81:152-163. [PMID: 32359044 PMCID: PMC7201207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/21/2019] [Indexed: 03/29/2024] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the costs and cost-effectiveness of two treatments for 101 alcohol use disorder patients and their intimate partners--group behavioral couples' therapy plus individual-based treatment (G-BCT), or standard behavioral couples' therapy plus individual-based treatment (S-BCT). METHOD We estimated the per-patient cost of each intervention using a microcosting approach that allowed us to estimate costs of specific components in each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of G-BCT relative to S-BCT. Immediately after treatment and 12 months after treatment, we computed incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves for percentage days abstinent, adverse consequences of alcohol and drugs, and overall relationship functioning. RESULTS The average per-patient cost of delivering G-BCT was $674, significantly less than the cost of S-BCT ($831). However, 12 months after treatment, S-BCT participants performed better on all outcomes compared with those in G-BCT, and the calculated ICER moving from G-BCT to S-BCT ranged from $10 to $12 across these outcomes. The current findings indicated that, except at very low willingness-to-pay values, S-BCT is a cost-effective option relative to G-BCT when considering 12-month posttreatment outcomes. CONCLUSIONS As expected, G-BCT was delivered at a lower cost per patient than S-BCT; however, S-BCT performed better over time on the clinical outcomes studied. These economic findings indicate that alcohol use disorder treatment providers should seriously consider S-BCT over G-BCT when deciding what format to use in behavioral couples' therapy.
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Affiliation(s)
| | - Timothy J. O’Farrell
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts
- Harvard Medical School Department of Psychiatry, Boston, Massachusetts
| | - Jeremiah A. Schumm
- School of Professional Psychology, Wright State University, Ellis Human Development Institute, Dayton, Ohio
| | | | - Marie Murphy
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts
- Harvard Medical School Department of Psychiatry, Boston, Massachusetts
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Dunlap LJ, Orme S, Zarkin GA, Arias SA, Miller IW, Camargo CA, Sullivan AF, Allen MH, Goldstein AB, Manton AP, Clark R, Boudreaux ED. Screening and Intervention for Suicide Prevention: A Cost-Effectiveness Analysis of the ED-SAFE Interventions. Psychiatr Serv 2019; 70:1082-1087. [PMID: 31451063 DOI: 10.1176/appi.ps.201800445] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Suicide screening followed by an intervention may identify suicidal individuals and prevent recurring self-harm, but few cost-effectiveness studies have been conducted. This study sought to determine whether the increased costs of implementing screening and intervention in hospital emergency departments (EDs) are justified by improvements in patient outcomes (decreased attempts and deaths by suicide). METHODS The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study recruited participants in eight U.S. EDs between August 2010 and November 2013. The eight sites sequentially implemented two interventions: universal screening added to treatment as usual and universal screening plus a telephone-based intervention delivered over 12 months post-ED visit. This study calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves to evaluate screening and suicide outcome measures and costs for the two interventions relative to treatment as usual. Costs were calculated from the provider perspective (e.g., wage and salary data and rental costs for hospital space) per patient and per site. RESULTS Average per-patient costs to a participating ED of universal screening plus intervention were $1,063 per month, approximately $500 more than universal screening added to treatment as usual. Universal screening plus intervention was more effective in preventing suicides compared with universal screening added to treatment as usual and treatment as usual alone. CONCLUSIONS Although the choice of universal screening plus intervention depends on the value placed on the outcome by decision makers, results suggest that implementing such suicide prevention measures can lead to significant cost savings.
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Affiliation(s)
- Laura J Dunlap
- RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux)
| | - Stephen Orme
- RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux)
| | - Gary A Zarkin
- RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux)
| | - Sarah A Arias
- RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux)
| | - Ivan W Miller
- RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux)
| | - Carlos A Camargo
- RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux)
| | - Ashley F Sullivan
- RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux)
| | - Michael H Allen
- RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux)
| | - Amy B Goldstein
- RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux)
| | - Anne P Manton
- RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux)
| | - Robin Clark
- RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux)
| | - Edwin D Boudreaux
- RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux)
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Dunlap LJ, Zarkin GA, Orme S, Meinhofer A, Kelly SM, O'Grady KE, Gryczynski J, Mitchell SG, Schwartz RP. Re-engineering methadone-Cost-effectiveness analysis of a patient-centered approach to methadone treatment. J Subst Abuse Treat 2018; 94:81-90. [PMID: 30243422 DOI: 10.1016/j.jsat.2018.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/23/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
Methadone maintenance treatment has proven effectiveness in the treatment of opioid use disorder, but significant barriers remain to treatment retention. In a randomized clinical trial, 300 newly-admitted methadone patients were randomly assigned to patient-centered methadone (PCM) v. treatment-as-usual (TAU). In PCM, participants were treated under revised program rules which permitted voluntary attendance at counseling and other changes focused on reducing involuntary discharge, and different staff roles which shifted disciplinary responsibility from the participant's counselor to the supervisor. The study found no significant differences in treatment retention, measures of opioid use, or other patient outcomes. This paper employs an activity-based costing approach to estimate the cost and cost-effectiveness of the two study conditions. We found that service use and costs were similar between PCM and TAU. Specifically, the average cost for PCM patients was $2396 compared to $2292 for standard methadone, while the average length of stay was 2 weeks longer for PCM patients. Incremental cost-effectiveness ratios (ICER) for self-reported heroin use, opioid positive urine screens, and meeting DSM-IV criteria for opioid dependence were mixed, with TAU achieving non-significantly better outcomes at lower treatment episode costs (i.e., economically dominating) for opioid positive urine screens. PCM patients reported slightly more days abstinent from heroin and fewer meet the opioid dependence criteria. While these differences are small and not statistically significant, we can still examine the cost-effectiveness implications. For days, abstinent from heroin, the ICER was $242 for one additional day of abstinence, however, there was notable uncertainty around this estimate. For opioid dependence criteria, the ICER was $1160 for a one-percentage point increase in the probability that a participant no longer met criteria for opioid dependence at follow-up. This economic study finds that patient choice concepts can be introduced into methadone treatment without significant impacts on costs or patient outcomes.
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Affiliation(s)
- Laura J Dunlap
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States of America.
| | - Gary A Zarkin
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States of America
| | - Stephen Orme
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States of America
| | - Angelica Meinhofer
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States of America
| | - Sharon M Kelly
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Kevin E O'Grady
- University of Maryland College Park, Department of Psychology, 4094 Campus Dr., College Park, MD 20742, United States of America
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Shannon G Mitchell
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
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Holloway AS, Ferguson J, Landale S, Cariola L, Newbury-Birch D, Flynn A, Knight JR, Sherritt L, Harris SK, O’Donnell AJ, Kaner E, Hanratty B, Loree AM, Yonkers KA, Ondersma SJ, Gilstead-Hayden K, Martino S, Adam A, Schwartz RP, Wu LT, Subramaniam G, Sharma G, McNeely J, Berman AH, Kolaas K, Petersén E, Bendtsen P, Hedman E, Linderoth C, Müssener U, Sinadinovic K, Spak F, Gremyr I, Thurang A, Mitchell AM, Finnell D, Savage CL, Mahmoud KF, Riordan BC, Conner TS, Flett JAM, Scarf D, McRee B, Vendetti J, Gallucci KS, Robaina K, Clark BJ, Jones J, Reed KD, Hodapp RM, Douglas I, Burnham EL, Aagaard L, Cook PF, Harris BR, Yu J, Wolff M, Rogers M, Barbosa C, Wedehase BJ, Dunlap LJ, Mitchell SG, Dusek KA, Gryczynski J, Kirk AS, Oros MT, Hosler C, O’Grady KE, Brown BS, Angus C, Sherborne S, Gillespie D, Meier P, Brennan A, de Vargas D, Soares J, Castelblanco D, Doran KM, Wittman I, Shelley D, Rotrosen J, Gelberg L, Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Deng Y, Dziura J, Fiellin LE, O’Connor PG, Bedimo R, Gibert C, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Justice AC, Bryant KJ, Fiellin DA, Giles EL, Coulton S, Deluca P, Drummond C, Howel D, McColl E, McGovern R, Scott S, Stamp E, Sumnall H, Vale L, Alabani V, Atkinson A, Boniface S, Frankham J, Gilvarry E, Hendrie N, Howe N, McGeechan GJ, Ramsey A, Stanley G, Clephane J, Gardiner D, Holmes J, Martin N, Shevills C, Soutar M, Chi FW, Weisner C, Ross TB, Mertens J, Sterling SA, Shorter GW, Heather N, Bray J, Cohen HA, McPherson TL, Adam C, López-Pelayo H, Gual A, Segura-Garcia L, Colom J, Ornelas IJ, Doyle S, Donovan D, Duran B, Torres V, Gaume J, Grazioli V, Fortini C, Paroz S, Bertholet N, Daeppen JB, Satterfield JM, Gregorich S, Alvarado NJ, Muñoz R, Kulieva G, Vijayaraghavan M, Adam A, Cunningham JA, Díaz E, Palacio-Vieira J, Godinho A, Kushir V, O’Brien KHM, Aguinaldo LD, Sellers CM, Spirito A, Chang G, Blake-Lamb T, LaFave LRA, Thies KM, Pepin AL, Sprangers KE, Bradley M, Jorgensen S, Catano NA, Murray AR, Schachter D, Andersen RM, Rey GN, Vahidi M, Rico MW, Baumeister SE, Johansson M, Sinadinovic C, Hermansson U, Andreasson S, O’Grady MA, Kapoor S, Akkari C, Bernal C, Pappacena K, Morley J, Auerbach M, Neighbors CJ, Kwon N, Conigliaro J, Morgenstern J, Magill M, Apodaca TR, Borsari B, Hoadley A, Scott Tonigan J, Moyers T, Fitzgerald NM, Schölin L, Barticevic N, Zuzulich S, Poblete F, Norambuena P, Sacco P, Ting L, Beaulieu M, Wallace PG, Andrews M, Daley K, Shenker D, Gallagher L, Watson R, Weaver T, Bruguera P, Oliveras C, Gavotti C, Barrio P, Braddick F, Miquel L, Suárez M, Bruguera C, Brown RL, Capell JW, Paul Moberg D, Maslowsky J, Saunders LA, McCormack RP, Scheidell J, Gonzalez M, Bauroth S, Liu W, Lindsay DL, Lincoln P, Hagle H, Wallhed Finn S, Hammarberg A, Andréasson S, King SE, Vargo R, Kameg BN, Acquavita SP, Van Loon RA, Smith R, Brehm BJ, Diers T, Kim K, Barker A, Jones AL, Skinner AC, Hinman A, Svikis DS, Thacker CL, Resnicow K, Beatty JR, Janisse J, Puder K, Bakshi AS, Milward JM, Kimergard A, Garnett CV, Crane D, Brown J, West R, Michie S, Rosendahl I, Andersson C, Gajecki M, Blankers M, Donoghue K, Lynch E, Maconochie I, Phillips C, Pockett R, Phillips T, Patton R, Russell I, Strang J, Stewart MT, Quinn AE, Brolin M, Evans B, Horgan CM, Liu J, McCree F, Kanovsky D, Oberlander T, Zhang H, Hamlin B, Saunders R, Barton MB, Scholle SH, Santora P, Bhatt C, Ahmed K, Hodgkin D, Gao W, Merrick EL, Drebing CE, Larson MJ, Sharma M, Petry NM, Saitz R, Weisner CM, Young-Wolff KC, Lu WY, Blosnich JR, Lehavot K, Glass JE, Williams EC, Bensley KM, Chan G, Dombrowski J, Fortney J, Rubinsky AD, Lapham GT, Forray A, Olmstead TA, Gilstad-Hayden K, Kershaw T, Dillon P, Weaver MF, Grekin ER, Ellis JD, McGoron L, McGoron L. Proceedings of the 14th annual conference of INEBRIA. Addict Sci Clin Pract 2017. [PMCID: PMC5606215 DOI: 10.1186/s13722-017-0087-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Oramasionwu CU, Cole AL, Dixon MS, Blalock SJ, Zarkin GA, Dunlap LJ, Zule WA. Estimated Cost of Injectable Medication Waste Attributable to Syringe Dead Space. JAMA Intern Med 2016; 176:1025-7. [PMID: 27273429 DOI: 10.1001/jamainternmed.2016.2301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christine U Oramasionwu
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill
| | - Ashley L Cole
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill
| | - Matthew S Dixon
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill
| | - Susan J Blalock
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill
| | - Gary A Zarkin
- RTI International, Research Triangle Park, North Carolina
| | - Laura J Dunlap
- RTI International, Research Triangle Park, North Carolina
| | - William A Zule
- RTI International, Research Triangle Park, North Carolina
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O'Farrell TJ, Schumm JA, Dunlap LJ, Murphy MM, Muchowski P. A randomized clinical trial of group versus standard behavioral couples therapy plus individually based treatment for patients with alcohol dependence. J Consult Clin Psychol 2016; 84:497-510. [PMID: 26963601 PMCID: PMC4873359 DOI: 10.1037/ccp0000089] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Multiple studies show that behavioral couples therapy (BCT) is more efficacious than individually based therapy (IBT) for substance use and relationship outcomes among patients with alcohol use disorder. To facilitate dissemination, a multicouple, rolling admission Group BCT (G-BCT) format has been suggested as an alternative to the 1 couple at a time, conjoint Standard BCT (S-BCT) format. This randomized study compared outcomes of G-BCT versus S-BCT over a 1-year follow-up. The authors predicted that G-BCT, as compared to S-BCT, would have equivalent (i.e., noninferior) improvements on substance and relationship outcomes. METHOD Participants were patients (N = 101) with alcohol dependence and their heterosexual relationship partners without substance use disorder. Participants were mostly White, in their 40s, and 30% of patients were women. Patients were randomized to either G-BCT plus 12-step-oriented IBT or S-BCT plus IBT. Primary outcomes included Timeline Followback Interview percentage days abstinent and Inventory of Drug Use Consequences measure of substance-related problems. Secondary outcome was Dyadic Adjustment Scale. Outcome data were collected at baseline, posttreatment, and quarterly for 1-year follow-up. RESULTS Results overall found no support for the predicted statistical equivalency of G-BCT and S-BCT. Rather than the predicted equivalent outcomes, substance and relationship outcomes were significantly worse for G-BCT than S-BCT in the last 6-9 months of the 12-month follow-up period, because G-BCT deteriorated and S-BCT maintained gains during follow-up. CONCLUSION This was the first study of the newer rolling admission group format for BCT. It proved to have worse not equivalent outcomes compared to standard conjoint BCT. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Marie M Murphy
- Families and Addiction Program, VA Boston Healthcare System
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Dunlap LJ, Han B, Dowd WN, Cowell AJ, Forman-Hoffman VL, Davies MC, Colpe LJ. Behavioral Health Outcomes Among Adults: Associations With Individual and Community-Level Economic Conditions. Psychiatr Serv 2016; 67:71-7. [PMID: 26325454 DOI: 10.1176/appi.ps.201400016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study examined the relationship between state and local economic conditions and serious psychological distress, substance use disorders, and mental health service utilization among adults in the United States. METHODS Using data from 21,100 adults who responded to the 2008-2010 National Survey on Drug Use and Health, a nationally representative survey of the U.S. civilian noninstitutionalized population living in households, the study used multivariate methods to examine associations between selected macroeconomic conditions and behavioral health outcomes. RESULTS Living in states in the top three quartiles for serious mortgage delinquency rate and in counties in the top three quartiles for unemployment rate was associated with a lower likelihood of using mental health services among individuals experiencing serious psychological distress (adjusted relative risk [ARR]=.54, .52, and .73, and ARR=.58, .62, and .71, respectively, versus quartile 1). Individual-level characteristics were the primary predictors associated with higher odds of having substance use disorders or experiencing serious psychological distress, but macroeconomic variables were not statistically significant predictors of these outcomes. CONCLUSIONS Both individual-level socioeconomic characteristics and population-level macroeconomic conditions were associated with behavioral health outcomes. Prevalence of serious psychological distress and substance use disorders and use of mental health services varied by economic measure. The findings suggest that access to and availability of mental health services for individuals experiencing serious psychological distress may be more challenging for those who do not have health insurance or who reside in regions with higher rates of mortgage foreclosures or higher rates of unemployment.
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Affiliation(s)
- Laura J Dunlap
- Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - Beth Han
- Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - William N Dowd
- Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - Alexander J Cowell
- Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - Valerie L Forman-Hoffman
- Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - M Christine Davies
- Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - Lisa J Colpe
- Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
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Barbosa C, Dunlap LJ, Wedehase B, Mitchell SG, Schwartz RP, Dusek K, Kirk AS, Oros M, Hosler C, Gryczynski J, Brown BS. Start-up costs of implementing Screening and Brief Intervention (SBI) for Adolescents (part of Economics of SBI symposium). Addict Sci Clin Pract 2015. [PMCID: PMC4596965 DOI: 10.1186/1940-0640-10-s2-o5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Mitchell SG, Kirk AS, Oros M, Gryczynski J, Dusek K, Hosler C, Schwartz RP, Brown BS, Barbosa C, Dunlap LJ, Lounsbury DW, O'Grady KE. Implementing adolescent SBIRT in an urban federally qualified health center: generalist vs. specialist service delivery models. Addict Sci Clin Pract 2015. [PMCID: PMC4596960 DOI: 10.1186/1940-0640-10-s2-o24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Lackner JM, Keefer L, Jaccard J, Firth R, Brenner D, Bratten J, Dunlap LJ, Ma C, Byroads M. The Irritable Bowel Syndrome Outcome Study (IBSOS): rationale and design of a randomized, placebo-controlled trial with 12 month follow up of self- versus clinician-administered CBT for moderate to severe irritable bowel syndrome. Contemp Clin Trials 2012; 33:1293-310. [PMID: 22846389 PMCID: PMC3468694 DOI: 10.1016/j.cct.2012.07.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 07/21/2012] [Accepted: 07/23/2012] [Indexed: 12/16/2022]
Abstract
Irritable bowel syndrome is a common, oftentimes disabling, gastrointestinal disorder whose full range of symptoms has no satisfactory medical or dietary treatment. One of the few empirically validated treatments includes a specific psychological therapy called cognitive behavior therapy which, if available, is typically administered over several months by trained practitioners in tertiary care settings. There is an urgent need to develop more efficient versions of CBT that require minimal professional assistance but retain the efficacy profile of clinic based CBT. The Irritable Bowel Syndrome Outcome Study (IBSOS) is a multicenter, placebo-controlled randomized trial to evaluate whether a self-administered version of CBT is, at least as efficacious as standard CBT and more efficacious than an attention control in reducing core GI symptoms of IBS and its burden (e.g. distress, quality of life impairment, etc.) in moderately to severely affected IBS patients. Additional goals are to assess, at quarterly intervals, the durability of treatment response over a 12 month period; to identify clinically useful patient characteristics associated with outcome as a way of gaining an understanding of subgroups of participants for whom CBT is most beneficial; to identify theory-based change mechanisms (active ingredients) that explain how and why CBT works; and evaluate the economic costs and benefits of CBT. Between August 2010 when IBSOS began recruiting subjects and February 2012, the IBSOS randomized 171 of 480 patients. Findings have the potential to improve the health of IBS patients, reduce its social and economic costs, conserve scarce health care resources, and inform evidence-based practice guidelines.
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Affiliation(s)
- Jeffrey M Lackner
- Department of Medicine, University at Buffalo School of Medicine, SUNY, Buffalo, NY, USA.
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23
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Zarkin GA, Cowell AJ, Hicks KA, Mills MJ, Belenko S, Dunlap LJ, Houser KA, Keyes V. Benefits and costs of substance abuse treatment programs for state prison inmates: results from a lifetime simulation model. Health Econ 2012; 21:633-52. [PMID: 21506193 PMCID: PMC3165106 DOI: 10.1002/hec.1735] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 12/20/2010] [Accepted: 03/10/2011] [Indexed: 05/30/2023]
Abstract
Reflecting drug use patterns and criminal justice policies throughout the 1990s and 2000s, prisons hold a disproportionate number of society's drug abusers. Approximately 50% of state prisoners meet the criteria for a diagnosis of drug abuse or dependence, but only 10% receive medically based drug treatment. Because of the link between substance abuse and crime, treating substance abusing and dependent state prisoners while incarcerated has the potential to yield substantial economic benefits. In this paper, we simulate the lifetime costs and benefits of improving prison-based substance abuse treatment and post-release aftercare for a cohort of state prisoners. Our model captures the dynamics of substance abuse as a chronic disease; estimates the benefits of substance abuse treatment over individuals' lifetimes; and tracks the costs of crime and criminal justice costs related to policing, adjudication, and incarceration. We estimate net societal benefits and cost savings to the criminal justice system of the current treatment system and five policy scenarios. We find that four of the five policy scenarios provide positive net societal benefits and cost savings to the criminal justice system relative to the current treatment system. Our study demonstrates the societal gains to improving the drug treatment system for state prisoners.
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Affiliation(s)
- Gary A Zarkin
- RTI International, Research Triangle Park, NC 27709, USA.
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Zarkin GA, Dunlap LJ, Wedehase B, Cowell AJ. The effect of alternative staff time data collection methods on drug treatment service cost estimates. Eval Program Plann 2008; 31:427-435. [PMID: 18640722 DOI: 10.1016/j.evalprogplan.2008.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2007] [Revised: 05/22/2008] [Accepted: 06/01/2008] [Indexed: 05/26/2023]
Abstract
Although a limited number of service cost estimates exist, no study has evaluated how differences in the method used to collect the staff time allocation across treatment services contribute to differences in service cost estimates. Three alternative data collection methods for estimating service-level costs in methadone treatment programs were evaluated: key informants, staff surveys, and staff diaries. We analyzed data from 25 methadone clinics across the United States. Results indicate that for the three primary services offered at methadone clinics-individual counseling, group counseling, and methadone dosing-no statistically significant differences exist in the mean estimates of costs per session across programs. Of the other five services analyzed, we found no statistically significant differences in two of the mean costs per session and a small but statistically significant difference in another service. We found large and statistically significant differences in mean costs for two services, initial patient assessment and initial medical services. Although there is no gold standard available to judge which method is the best to use, we concluded that the key informant method yields more reliable cost estimates compared with the staff methods and is less burdensome to both the treatment programs and to researchers. Our findings suggest that the key informant method is the preferred method for costing substance abuse treatment services.
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Affiliation(s)
- Gary A Zarkin
- RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA
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25
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Abstract
OBJECTIVES To estimate a hybrid cost function of the relationship between total annual cost for outpatient methadone treatment and output (annual patient days and selected services), input prices (wages and building space costs), and selected program and patient case-mix characteristics. DATA SOURCES Data are from a multistate study of 159 methadone treatment programs that participated in the Center for Substance Abuse Treatment's Evaluation of the Methadone/LAAM Treatment Program Accreditation Project between 1998 and 2000. STUDY DESIGN Using least squares regression for weighted data, we estimate the relationship between total annual costs and selected output measures, wages, building space costs, and selected program and patient case-mix characteristics. PRINCIPAL FINDINGS Findings indicate that total annual cost is positively associated with program's annual patient days, with a 10 percent increase in patient days associated with an 8.2 percent increase in total cost. Total annual cost also increases with counselor wages (p<.01), but no significant association is found for nurse wages or monthly building costs. Surprisingly, program characteristics and patient case mix variables do not appear to explain variations in methadone treatment costs. Similar results are found for a model with services as outputs. CONCLUSIONS This study provides important new insights into the determinants of methadone treatment costs. Our findings concur with economic theory in that total annual cost is positively related to counselor wages. However, among our factor inputs, counselor wages are the only significant driver of these costs. Furthermore, our findings suggest that methadone programs may realize economies of scale; however, other important factors, such as patient access, should be considered.
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Affiliation(s)
- Laura J Dunlap
- RTI International, 6110 Executive Blvd., Suite 902, Rockville, MD 20852, USA
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Zarkin GA, Dunlap LJ, Belenko S, Dynia PA. A Benefit-Cost Analysis of the Kings County District Attorney's Office Drug Treatment Alternative to Prison (DTAP) Program. ACTA ACUST UNITED AC 2008. [DOI: 10.3818/jrp.7.1.2005.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In October 1990, the Kings County (Brooklyn, NY) District Attorney's Office implemented the Drug Treatment Alternative to Prison (DTAP) program to divert nonviolent felony drug offenders from prison to community-based residential drug treatment. This article presents an estimate of the costs and benefits of the DTAP program based on a cohort of DTAP participants and prison comparisons who entered treatment or prison in 1995–1996 and were tracked for 6 years. The analysis focuses on the criminal justice system (CJS) costs associated with criminal recidivism. Findings show that the DTAP program is cost-beneficial compared to the usual criminal justice process (benefit-cost ratio equals 2.17 after 6 years).
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Abstract
Using the 1992-1995 National Treatment Improvement Evaluation Study data, we employ principal components analysis to create treatment service factors based on both patient self-reports and treatment record extracts. We included these factors in multivariate models for 1,136 outpatient drug-free treatment patients to estimate the relationship between services and post-treatment employment and crime. Although our models indicated some significant predictors of employment and crime, the overall effects of services were generally insignificant. We conclude that either services are unrelated to outcomes or if they are related then we are not measuring the key aspects of service provision that may be important. The study's limitations are noted.
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Affiliation(s)
- Laura J Dunlap
- RTI International, Research Triangle Park, North Carolina, USA.
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28
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Abstract
The use of accreditation has been widespread among medical care providers, but accreditation is relatively new to the drug abuse treatment field. This study presents estimates of the costs of pursuing accreditation for methadone treatment sites. Data are from 102 methadone treatment sites that underwent accreditation as part of the Center for Substance Abuse Treatment's evaluation of the Opioid Treatment Program Accreditation Project. The analysis represents the most comprehensive analysis of the costs of pursuing accreditation by a health care provider. Importantly, it is the first analysis of the costs of pursuing accreditation by drug treatment providers. Policy makers and drug treatment providers can use this analysis to plan the labor requirements and costs of future accreditation initiatives.
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Affiliation(s)
- Gary A Zarkin
- RTI International, Behavioral Health Research Division, Research Triangle Park, NC 27709, USA.
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29
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Abstract
Several studies have examined the benefits and costs of drug treatment; however, they have typically focused on the benefits and costs of a single treatment episode. Although beneficial for certain analyses, the results are limited because they implicitly treat drug abuse as an acute problem that can be treated in one episode. We developed a Monte Carlo simulation model that incorporates the chronic nature of drug abuse. Our model represents the progression of individuals from the general population aged 18-60 with respect to their heroin use, treatment for heroin use, criminal behavior, employment, and health care use. We also present three model scenarios representing an increase in the probability of going to treatment, an increase in the treatment length of stay, and a scenario in which drug treatment is not available to evaluate how changes in treatment parameters affect model results. We find that the benefit-cost ratio of treatment from our lifetime model (37.72) exceeds the benefit-cost ratio from a static model (4.86). The model provides a rich characterization of the dynamics of heroin use and captures the notion of heroin use as a chronic recurring condition. Similar models can be developed for other chronic diseases, such as diabetes, mental illness, or cardiovascular disease.
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Affiliation(s)
- Gary A Zarkin
- RTI International, Research Triangle Park, NC 27709, USA.
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Zarkin GA, Dunlap LJ, Bray JW, Wechsberg WM. The effect of treatment completion and length of stay on employment and crime in outpatient drug-free treatment. J Subst Abuse Treat 2002; 23:261-71. [PMID: 12495788 DOI: 10.1016/s0740-5472(02)00273-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Length of stay in treatment has been found to be a significant predictor of positive post-treatment outcomes, such as decreases in unemployment and crime. However, length of stay may be an incomplete predictor of successful treatment. Surprisingly, few studies have examined whether completing treatment in addition to length of stay is an important factor in explaining positive treatment outcomes. The objective of our study is to examine the effect that treatment completion and length of stay have on post-treatment employment and crime for patients in outpatient drug-free treatment, the largest treatment modality in the United States. We use conditional logit and multiple regression models with program-level indicator variables (fixed effects) to estimate the effect of treatment completion and length of stay on employment and crime controlling for drug use severity, previous treatment history, and other patient demographics. Data are from the National Treatment Improvement Evaluation Study and include 986 adults enrolled in outpatient drug-free programs across the United States. We find that treatment completion and length of stay are significantly related to post-treatment employment. Holding length of stay constant, the occurrence of employment at follow-up among patients who complete their planned treatment is almost 2 times that of patients who do not complete treatment. However, treatment completion did not have a statistically significant effect on the probability of post-treatment crime. Although our results are mixed, these findings suggest that greater attention should be placed on evaluating the importance of both length of stay and treatment completion in treatment outcome studies.
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Affiliation(s)
- Gary A Zarkin
- RTI, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA.
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Abstract
Several policy changes are being debated in New York State that may affect the financing and delivery of methadone maintenance treatment. The goals of this article are to provide greater understanding of the potential impact of managed care on methadone treatment in New York State, and greater understanding of the consequences of arbitrary limits on methadone treatment. Toward these goals, in October 1996, we conducted 1-day site visits at five methadone treatment programs in New York State to learn their views and concerns, and to examine their strategic responses to potential changes in treatment financing and delivery. The treatment programs we visited expressed concern about subjecting methadone patients to any of the potential policy changes because they felt that, if implemented without regard for the special needs of methadone patients, these reforms could hurt treatment access, retention, and quality of care. All the programs stated that limits on treatment would increase drug use and, consequently, increase crime and risk of infectious disease, and cause overall deterioration of the community.
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Affiliation(s)
- G A Zarkin
- Health and Human Resource Economics Program, Research Triangle Institute, NC 27709-2194, USA.
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French MT, Dunlap LJ, Roman PM, Steele PD. Factors that influence the use and perceptions of employee assistance programs at six worksites. J Occup Health Psychol 1998. [PMID: 9552300 DOI: 10.1037//1076-8998.2.4.312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Employee assistance programs (EAPs) have gained significant importance in contemporary worksites. This article uses data from 6 case studies to examine several research questions regarding the relationship between worker demographic (e.g., gender, job tenure, and marital status), substance use, and workplace policies and the actual and potential use of the company EAP. Unlike in most of the existing literature, the authors did not find that gender, marital status, or job dissatisfaction are statistically related to actual or potential EAP use at most worksites. However, job tenure and some substance use behaviors were related to actual EAP use in a positive and statistically significant way. Another important finding, underlying the credible integration of EAPs into worksite culture, is the positive and robust relationship between employee trust and confidence in the EAP and actual use. The results of our study both reinforce some long-established principles in the EAP field and encourage further consideration of other beliefs.
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Affiliation(s)
- M T French
- Department of Economics, University of Miami, Florida 33136, USA.
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Abstract
Employee assistance programs (EAPs) have gained significant importance in contemporary worksites. This article uses data from 6 case studies to examine several research questions regarding the relationship between worker demographic (e.g., gender, job tenure, and marital status), substance use, and workplace policies and the actual and potential use of the company EAP. Unlike in most of the existing literature, the authors did not find that gender, marital status, or job dissatisfaction are statistically related to actual or potential EAP use at most worksites. However, job tenure and some substance use behaviors were related to actual EAP use in a positive and statistically significant way. Another important finding, underlying the credible integration of EAPs into worksite culture, is the positive and robust relationship between employee trust and confidence in the EAP and actual use. The results of our study both reinforce some long-established principles in the EAP field and encourage further consideration of other beliefs.
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Affiliation(s)
- M T French
- Department of Economics, University of Miami, Florida 33136, USA.
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French MT, Dunlap LJ, Zarkin GA, McGeary KA, McLellan AT. A structured instrument for estimating the economic cost of drug abuse treatment. The Drug Abuse Treatment Cost Analysis Program (DATCAP). J Subst Abuse Treat 1997; 14:445-55. [PMID: 9437614 DOI: 10.1016/s0740-5472(97)00132-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Drug abuse treatment programs need to know the cost of the services they provide. Indeed, continued public and private funding is now being linked to cost and performance measures, and programs can use financial data to improve organizational efficiency. However, one of the dangers of promoting cost studies at treatment programs is that most program staff are not technically prepared to perform a cost analysis and little user-friendly information is available to offer assistance. Furthermore, not all cost methods are consistent, which can lead to noncomparable estimates that are difficult to use for policy or planning purposes. Our paper tries to fill this gap in the research literature and provide treatment programs with a much-needed technical assistance tool. Specifically, we present a structured and scientifically-based instrument for estimating the economic cost of treatment services. The Drug Abuse Treatment Cost Analysis Program (DATCAP) is described in detail along with a companion instrument to analyze treatment financing; the Drug Abuse Treatment Financing Analysis Program (DATFin). The components of both instruments are outlined and findings from a variety of actual case studies are presented. Lastly, we discuss the DATCAP User's Manual, which will enable individual programs to begin collecting the necessary data and estimating economic costs at their own clinics.
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French MT, Dunlap LJ, Galinis DN, Rachal JV, Zarkin GA. Health Care Reforms and Managed Care for Substance Abuse Services: Findings from Eleven Case Studies. J Public Health Policy 1996. [DOI: 10.2307/3342697] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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