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Perez-Correa A, Abbas B, Riback L, Ghiroli M, Norton B, Murphy S, Jakubowski A, Hayes BT, Cunningham CO, Fox AD. Onsite buprenorphine inductions at harm reduction agencies to increase treatment engagement and reduce HIV risk: Design and rationale. Contemp Clin Trials 2022; 114:106674. [PMID: 34990854 PMCID: PMC10123766 DOI: 10.1016/j.cct.2021.106674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite dramatic increases in opioid use disorder (OUD) and overdose deaths, the U.S. has been unable to consistently deliver OUD treatment to those who need it. Syringe services programs (SSPs) can engage an out-of-treatment population of people with OUD that has elevated overdose risk. Buprenorphine treatment is safe and effective, and US regulations allow for prescribing from diverse locations, including SSPs. This study's objective is to test buprenorphine treatment initiation at SSPs. We hypothesize that offering onsite buprenorphine treatment initiation will improve OUD treatment engagement without reducing buprenorphine treatment effectiveness or safety. METHODS We will recruit 250 out-of-treatment SSP participants with OUD in a large urban area. Participants will be randomized to onsite buprenorphine treatment initiation or enhanced referral. Over 2 weeks, participants in the onsite treatment arm will see a buprenorphine provider twice at the SSP, receive weekly medication packs, and then their care will be transferred to a community health center for treatment continuation. In the control arm, within one week, participants will receive an appointment at the same community health center as in the intervention arm for buprenorphine initiation and continuation. Participants will be assessed with urine drug tests, questionnaires, and medical record review. The primary outcome will be engagement in buprenorphine treatment at 30 days. Secondary outcomes include buprenorphine diversion, opioid-free urine drug tests, and intervention cost-effectiveness. DISCUSSION Our study will contribute to the growing literature on SSPs as a conduit to OUD treatment. SSPs hold promise to deliver needed care to people with OUD.
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Affiliation(s)
- Andres Perez-Correa
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America.
| | - Bilal Abbas
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America
| | - Lindsey Riback
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America
| | - Megan Ghiroli
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, United States of America
| | - Brianna Norton
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America; Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, United States of America
| | - Sean Murphy
- Weill Cornell Medicine, Department of Population Health Sciences, 425 East 61st Street, Suite 301, New York, NY 10065-8722, United States of America
| | - Andrea Jakubowski
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America; Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, United States of America
| | - Benjamin T Hayes
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America; Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, United States of America
| | - Chinazo O Cunningham
- NYC Department of Health and Mental Hygiene, 42-09 28th Street, CN 2, Long Island City, NY 11101-4132, United States of America
| | - Aaron D Fox
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America; Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, United States of America
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Papp MA, Leff JA, Murphy SM, Yang A, Crane HM, Metsch LR, Del Rio C, Feaster DJ, Rich JD, Schackman BR, McCollister KE. Harmonizing healthcare and other resource measures for evaluating economic costs in substance use disorder research. Subst Abuse Treat Prev Policy 2021; 16:32. [PMID: 33832483 PMCID: PMC8033702 DOI: 10.1186/s13011-021-00356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Standardization and harmonization of healthcare resource utilization data can improve evaluations of the economic impact of treating people with substance use disorder (SUD), including reductions in use of expensive hospital and emergency department (ED) services, and can ensure consistency with current cost-effectiveness and cost-benefit analysis guidelines. METHODS We examined self-reported healthcare and other resource utilization data collected at baseline from three National Institute on Drug Abuse (NIDA)-funded Seek, Test, Treat, and Retain intervention studies of individuals living with/at risk for HIV with SUD. Costs were calculated by multiplying mean healthcare resource utilization measures by monetary conversion factors reflecting cost per unit of care. We normalized baseline recall timeframes to past 30 days and evaluated for missing data. RESULTS We identified measures that are feasible and appropriate for estimating healthcare sector costs including ED visits, inpatient hospital and residential facility stays, and outpatient encounters. We also identified two self-reported measures to inform societal costs (days experiencing SUD problems, participant spending on substances). Missingness was 8% or less for all study measures and was lower for single questions measuring utilization in a recall period. CONCLUSIONS We recommend including measures representing units of service with specific recall periods (e.g., 6 months vs. lifetime), and collecting healthcare resource utilization data using single-question measures to reduce missingness.
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Affiliation(s)
- Michelle A. Papp
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065 USA
| | - Jared A. Leff
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065 USA
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065 USA
| | - April Yang
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL 33136 USA
| | - Heidi M. Crane
- Department of Infectious Diseases, University of Washington School of Medicine, Box 359931, Harborview Medical Center, 325 9th Ave, Seattle, WA 98104 USA
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 168th St, New York, NY 10032 USA
| | - Carlos Del Rio
- Emory University School of Medicine, Grady Memorial Hospital, Emory Center for AIDS Research, 201 Dowman Drive, Atlanta, GA 30322 USA
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL 33136 USA
| | - Josiah D. Rich
- The Miriam Hospital, Brown University, 164 Summit Ave, Providence, RI 02906 USA
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065 USA
| | - Kathryn E. McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL 33136 USA
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Murphy SM, Jeng PJ, Poole SA, Jalali A, Vocci FJ, Gordon MS, Woody GE, Polsky D. Health and economic outcomes of treatment with extended-release naltrexone among pre-release prisoners with opioid use disorder (HOPPER): protocol for an evaluation of two randomized effectiveness trials. Addict Sci Clin Pract 2020; 15:15. [PMID: 32321570 PMCID: PMC7178627 DOI: 10.1186/s13722-020-00188-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/08/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Persons with an opioid use disorder (OUD) who were incarcerated face many challenges to remaining abstinent; concomitantly, opioid-overdose is the leading cause of death among this population, with the initial weeks following release proving especially fatal. Extended-release naltrexone (XR-NTX) is the most widely-accepted, evidence-based OUD pharmacotherapy in criminal justice settings, and ensures approximately 30 days of protection from opioid overdose. The high cost of XR-NTX serves as a barrier to uptake by many prison/jail systems; however, the cost of the medication should not be viewed in isolation. Prison/jail healthcare budgets are ultimately determined by policymakers, and the benefits/cost-offsets associated with effective OUD treatment will directly and indirectly affect their overall budgets, and society as a whole. METHODS This protocol describes a study funded by the National Institute of Drug Abuse (NIDA) to: evaluate changes in healthcare utilization, health-related quality-of-life, and other resources associated with different strategies of XR-NTX delivery to persons with OUD being released from incarceration; and estimate the relative "value" of each strategy. Data from two ongoing, publicly-funded, randomized-controlled trials will be used to evaluate these questions. In Study A, (XR-NTX Before vs. After Reentry), participants are randomized to receive their first XR-NTX dose before release, or at a nearby program post-release. In Study B, (enhanced XR-NTX vs. XR-NTX), both arms receive XR-NTX prior to release; the enhanced arm receives mobile medical (place of residence) XR-NTX treatment post-release, and the XR-NTX arm receives referral to a community treatment program post-release. The economic data collection instruments required to evaluate outcomes of interest were incorporated into both studies from baseline. Moreover, because the same instruments are being used in both trials on comparable populations, we have the opportunity to not only assess differences in outcomes between study arms within each trial, but also to merge the data sets and test for differences across trials. DISCUSSION Initiating XR-NTX for OUD prior to release from incarceration may improve patient health and well-being, while also producing downstream cost-offsets. This study offers the unique opportunity to assess the effectiveness and cost-effectiveness of multiple strategies, according to different stakeholder perspectives.
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Affiliation(s)
- Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY, 10065, USA.
| | - Philip J Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY, 10065, USA
| | - Sabrina A Poole
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY, 10065, USA
| | | | | | - George E Woody
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Polsky
- Department of Health Policy and Management, Bloomberg School of Public Health, Carey Business School, Johns Hopkins University, Baltimore, MD, USA
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The Value of High School Graduation in the United States: Per-Person Shadow Price Estimates for Use in Cost–Benefit Analysis. ADMINISTRATIVE SCIENCES 2019. [DOI: 10.3390/admsci9040081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
One way for jurisdictions with limited analytic resources to increase their capability for doing cost–benefit analysis (CBA) is to use existing shadow prices, or “plug-ins”, for important social impacts. This article contributes to the further development of one important shadow price: the value of an additional high school graduation in the United States. Specifically, how valuable to a student, government, and the rest of society in aggregate is a high school graduation? The analysis builds on the method developed by the Washington State Institute for Public Policy and presents numerical updates and extensions to their analysis. For the U.S., the estimated net present value (the social value) using a 3 percent real discount rate of this shadow price is approximately $300,000 per each additional graduate. In appropriate circumstances, this value can be “plugged-in” to CBAs of policies that either directly or indirectly seeks to increase the number of students who graduate from high school.
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