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- Title
Estimated Clinical Outcomes and Cost-effectiveness Associated With Provision of Addiction Treatment in US Primary Care Clinics.
- Authors
Jawa, Raagini; Tin, Yjuliana; Nall, Samantha; Calcaterra, Susan L.; Savinkina, Alexandra; Marks, Laura R.; Kimmel, Simeon D.; Linas, Benjamin P.; Barocas, Joshua A.
- Abstract
Key Points: Question: What are the estimated clinical outcomes, costs, and cost-effectiveness of integrating buprenorphine and harm reduction kits into primary care for people who inject opioids? Findings: In this decision analytical model using the Reducing Infections Related to Drug Use Cost-Effectiveness model, integrating buprenorphine alone extended discounted life expectancy by 0.16 years and buprenorphine combined with harm reduction kits extended discounted life expectancy by 0.17 years. Compared with the status quo, buprenorphine and harm reduction kits reduced drug use–related mortality by 33% and was cost-effective. Meaning: These findings suggest that integrating buprenorphine and harm reduction kits into primary care may improve clinical outcomes, modestly increase costs, and be cost-effective to health systems. This decision analytical model of a simulated representative cohort of people who inject opioids estimates the long-term clinical outcomes, costs, and cost-effectiveness of different strategies of integrating addiction treatment into US primary care. Importance: US primary care practitioners (PCPs) are the largest clinical workforce, but few provide addiction care. Primary care is a practical place to expand addiction services, including buprenorphine and harm reduction kits, yet the clinical outcomes and health care sector costs are unknown. Objective: To estimate the long-term clinical outcomes, costs, and cost-effectiveness of integrated buprenorphine and harm reduction kits in primary care for people who inject opioids. Design, Setting, and Participants: In this modeling study, the Reducing Infections Related to Drug Use Cost-Effectiveness (REDUCE) microsimulation model, which tracks serious injection-related infections, overdose, hospitalization, and death, was used to examine the following treatment strategies: (1) PCP services with external referral to addiction care (status quo), (2) PCP services plus onsite buprenorphine prescribing with referral to offsite harm reduction kits (BUP), and (3) PCP services plus onsite buprenorphine prescribing and harm reduction kits (BUP plus HR). Model inputs were derived from clinical trials and observational cohorts, and costs were discounted annually at 3%. The cost-effectiveness was evaluated over a lifetime from the modified health care sector perspective, and sensitivity analyses were performed to address uncertainty. Model simulation began January 1, 2021, and ran for the entire lifetime of the cohort. Main Outcomes and Measures: Life-years (LYs), hospitalizations, mortality from sequelae (overdose, severe skin and soft tissue infections, and endocarditis), costs, and incremental cost-effectiveness ratios (ICERs). Results: The simulated cohort included 2.25 million people and reflected the age and gender of US persons who inject opioids. Status quo resulted in 6.56 discounted LYs at a discounted cost of $203 500 per person (95% credible interval, $203 000-$222 000). Each strategy extended discounted life expectancy: BUP by 0.16 years and BUP plus HR by 0.17 years. Compared with status quo, BUP plus HR reduced sequelae-related mortality by 33%. The mean discounted lifetime cost per person of BUP and BUP plus HR were more than that of the status quo strategy. The dominating strategy was BUP plus HR. Compared with status quo, BUP plus HR was cost-effective (ICER, $34 400 per LY). During a 5-year time horizon, BUP plus HR cost an individual PCP practice approximately $13 000. Conclusions and Relevance: This modeling study of integrated addiction service in primary care found improved clinical outcomes and modestly increased costs. The integration of addiction service into primary care practices should be a health care system priority.
- Subjects
UNITED States; INTRAVENOUS drug abuse; BUPRENORPHINE; MEDICAL care; SIMULATION methods in education; PRIMARY health care; TREATMENT effectiveness; HARM reduction; COMPARATIVE studies; COST effectiveness; DESCRIPTIVE statistics; RESEARCH funding; EVALUATION
- Publication
JAMA Network Open, 2023, Vol 6, Issue 4, pe237888
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.7888