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Montoya ID, Watson C, Aldridge A, Ryan D, Murphy SM, Amuchi B, McCollister KE, Schackman BR, Bush JL, Speer D, Harlow K, Orme S, Zarkin GA, Castry M, Seiber EE, Barocas JA, Linas BP, Starbird LE. Cost of start-up activities to implement a community-level opioid overdose reduction intervention in the HEALing Communities Study. Addict Sci Clin Pract 2024; 19:23. [PMID: 38566249 PMCID: PMC10988809 DOI: 10.1186/s13722-024-00454-w] [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] [Received: 04/02/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Communities That HEAL (CTH) is a novel, data-driven community-engaged intervention designed to reduce opioid overdose deaths by increasing community engagement, adoption of an integrated set of evidence-based practices, and delivering a communications campaign across healthcare, behavioral-health, criminal-legal, and other community-based settings. The implementation of such a complex initiative requires up-front investments of time and other expenditures (i.e., start-up costs). Despite the importance of these start-up costs in investment decisions to stakeholders, they are typically excluded from cost-effectiveness analyses. The objective of this study is to report a detailed analysis of CTH start-up costs pre-intervention implementation and to describe the relevance of these data for stakeholders to determine implementation feasibility. METHODS This study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states-Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars. RESULTS State-level average and median start-up cost (representing 8-10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost. CONCLUSION We identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.
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Affiliation(s)
- Iván D Montoya
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Danielle Ryan
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Brenda Amuchi
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Joshua L Bush
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Drew Speer
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Kristin Harlow
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Stephen Orme
- RTI International, Research Triangle Park, NC, USA
| | | | - Mathieu Castry
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Eric E Seiber
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Joshua A Barocas
- Sections of General Internal Medicine and Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Benjamin P Linas
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Laura E Starbird
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
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McCollister KE, Gordon AJ, Acevedo A, Voshtina D, Li JM, Tse B, Murphy SM. The 2023 Addiction Health Services Research Conference: Back in Person and Taking a Bite of the Big Apple. Subst Use Addctn J 2024; 45:163-167. [PMID: 38288727 DOI: 10.1177/29767342231225577] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The Addiction Health Services Research (AHSR) Conference has been held since 2002. This Conference brings together researchers, graduate students, policymakers, and treatment providers to focus improving the organization, distribution, and financing of healthcare resources for prevention/care of SUD. The AHSR 2023 Conference took place in New York City, October 18-20th, and was hosted by the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH; cherishresearch.org). Attended by more than 300 participants, the Conference comprised several themes relating to the latest research on addiction health services delivery, financing, and impact. The agenda also included pre-conference workshops, distinguished plenary speakers, a multitude of networking opportunities, and career support for early-stage and minority investigators. AHSR 2023 featured 3 plenary sessions, 120 oral presentations, and 143 poster presentations from academics throughout the world. Overall, AHSR 2023 provided numerous opportunities to advance the field of addiction health services research. The state-of-the-art techniques and insights gained by attending scholars will position them to be change-agents in the addiction field going forward.
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Affiliation(s)
- Kathryn E McCollister
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | | | - Dorela Voshtina
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jazmine M Li
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Bonnie Tse
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Sean M Murphy
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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Young AM, Havens JR, Cooper HLF, Fallin-Bennett A, Fanucchi L, Freeman PR, Knudsen H, Livingston MD, McCollister KE, Stone J, Vickerman P, Freeman E, Jahangir T, Larimore E, White CR, Cheatom C, Community Staff K, Design Team K. Kentucky Outreach Service Kiosk (KyOSK) Study protocol: a community-level, controlled quasi-experimental, type 1 hybrid effectiveness study to assess implementation, effectiveness and cost-effectiveness of a community-tailored harm reduction kiosk on HIV, HCV and overdose risk in rural Appalachia. BMJ Open 2024; 14:e083983. [PMID: 38431295 PMCID: PMC10910671 DOI: 10.1136/bmjopen-2024-083983] [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: 01/04/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Many rural communities bear a disproportionate share of drug-related harms. Innovative harm reduction service models, such as vending machines or kiosks, can expand access to services that reduce drug-related harms. However, few kiosks operate in the USA, and their implementation, impact and cost-effectiveness have not been adequately evaluated in rural settings. This paper describes the Kentucky Outreach Service Kiosk (KyOSK) Study protocol to test the effectiveness, implementation outcomes and cost-effectiveness of a community-tailored, harm reduction kiosk in reducing HIV, hepatitis C and overdose risk in rural Appalachia. METHODS AND ANALYSIS KyOSK is a community-level, controlled quasi-experimental, non-randomised trial. KyOSK involves two cohorts of people who use drugs, one in an intervention county (n=425) and one in a control county (n=325). People who are 18 years or older, are community-dwelling residents in the target counties and have used drugs to get high in the past 6 months are eligible. The trial compares the effectiveness of a fixed-site, staffed syringe service programme (standard of care) with the standard of care supplemented with a kiosk. The kiosk will contain various harm reduction supplies accessible to participants upon valid code entry, allowing dispensing data to be linked to participant survey data. The kiosk will include a call-back feature that allows participants to select needed services and receive linkage-to-care services from a peer recovery coach. The cohorts complete follow-up surveys every 6 months for 36 months (three preceding kiosk implementation and four post-implementation). The study will test the effectiveness of the kiosk on reducing risk behaviours associated with overdose, HIV and hepatitis C, as well as implementation outcomes and cost-effectiveness. ETHICS AND DISSEMINATION The University of Kentucky Institutional Review Board approved the protocol. Results will be disseminated in academic conferences and peer-reviewed journals, online and print media, and community meetings. TRIAL REGISTRATION NUMBER NCT05657106.
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Affiliation(s)
- April M Young
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Hannah L F Cooper
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Laura Fanucchi
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Patricia R Freeman
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky, USA
| | - Hannah Knudsen
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Melvin D Livingston
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Kathryn E McCollister
- Division of Health Services Research and Policy, University of Miami, Coral Gables, Florida, USA
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Edward Freeman
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
| | - Tasfia Jahangir
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Elizabeth Larimore
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Carol R White
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
| | | | - KyOSK Community Staff
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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Behrends CN, Leff JA, Lowry W, Li JM, Onuoha EN, Fardone E, Bayoumi AM, McCollister KE, Murphy SM, Schackman BR. Economic Evaluations of Establishing Opioid Overdose Prevention Centers in 12 North American cities: A Systematic Review. Value Health 2024:S1098-3015(24)00073-1. [PMID: 38401795 DOI: 10.1016/j.jval.2024.02.004] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Overdose prevention centers (OPCs) provide a safe place where people can consume preobtained drugs under supervision so that a life-saving medical response can be provided quickly in the event of an overdose. OPCs are programs that are established in Canada and have recently become legally sanctioned in only a few United States jurisdictions. METHODS We conducted a systematic review that summarizes and identifies gaps of economic evidence on establishing OPCs in North America to guide future expansion of OPCs. RESULTS We included 16 final studies that were evaluated with the Consolidated Health Economic Evaluation Reporting Standards and Drummond checklists. Eight studies reported cost-effectiveness results (eg, cost per overdose avoided or cost per quality-adjusted life-year), with 6 also including cost-benefit; 5 reported only cost-benefit results, and 3 cost offsets. Health outcomes primarily included overdose mortality outcomes or HIV/hepatitis C virus infections averted. Most studies used mathematical modeling and projected OPC outcomes using the experience of a single facility in Vancouver, BC. CONCLUSIONS OPCs were found to be cost-saving or to have favorable cost-effectiveness or cost-benefit ratios across all studies. Future studies should incorporate the experience of OPCs established in various settings and use a greater diversity of modeling designs.
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Affiliation(s)
- Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
| | - Jared A Leff
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Weston Lowry
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jazmine M Li
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Erica N Onuoha
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Erminia Fardone
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed M Bayoumi
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, 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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Fardone E, Montoya ID, Schackman BR, McCollister KE. Economic benefits of substance use disorder treatment: A systematic literature review of economic evaluation studies from 2003 to 2021. J Subst Use Addict Treat 2023; 152:209084. [PMID: 37302488 PMCID: PMC10530001 DOI: 10.1016/j.josat.2023.209084] [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: 07/27/2022] [Revised: 04/02/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The economic burden of substance use disorder (SUD) is significant, comprising costs of health care and social services, criminal justice resources, loss of productivity, and premature mortality. This study assembles and synthesizes two decades of evidence describing the benefits of SUD treatment across five main outcome domains; 1) health care utilization; 2) self-reported criminal activity by offense type; 3) criminal justice involvement collected from administrative records or self-reported; 4) productivity assessed through working hours or wages earned; and 5) social services (e.g., a day spent in transitional housing). METHODS This review included studies if they reported the monetary value of the intervention outcomes, most commonly through a cost-benefit or cost-effectiveness framework. The search included studies from 2003 to the present day as of this writing (up to October 15, 2021). Summary cost estimates were adjusted using the US Consumer Price Index (CPI) to reflect the 12-month benefits per client in USD 2021. We followed the PRISMA methodology for study selection and assessed quality using the Checklist for Health Economic Evaluation Reporting Standards (CHEERS). RESULTS The databases yielded 729 studies after removing duplicates, and we ultimately selected 12 for review. Studies varied widely regarding analytical approaches, time horizons, outcome domains, and other methodological factors. Among the ten studies that found positive economic benefits, reductions in criminal activity or criminal justice costs represented the largest or second largest component of these benefits (range $621 to $193,440 per client). CONCLUSIONS Consistent with previous findings, a reduction in criminal activity costs is driven by the relatively high societal cost per criminal offense, notably for violent crimes, such as aggravated assault and rape/sexual assault. Accepting the economic rationale for increased investment in SUD interventions will require recognizing that more benefits accrue to individuals by avoiding being victims of a crime than to governments through budget offsets resulting from savings in non-SUD program expenses. Future studies should explore individually tailored interventions to optimize care management, which may yield unexpected economic benefits to services utilization, and criminal activity data to estimate economic benefits across a broad range of interventions.
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Affiliation(s)
- Erminia Fardone
- Department of Public Health Sciences, Division of Health Services Research and Policy, University of Miami-Miller School of Medicine, United States of America.
| | - Iván D Montoya
- Department of Public Health Sciences, Division of Health Services Research and Policy, University of Miami-Miller School of Medicine, United States of America
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York United States of America
| | - Kathryn E McCollister
- Department of Public Health Sciences, Division of Health Services Research and Policy, University of Miami-Miller School of Medicine, United States of America
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Ryan DA, Montoya ID, Koutoujian PJ, Siddiqi K, Hayes E, Jeng PJ, Cadet T, McCollister KE, Murphy SM. Budget impact tool for the incorporation of medications for opioid use disorder into jail/prison facilities. J Subst Use Addict Treat 2023; 146:208943. [PMID: 36880906 PMCID: PMC10084043 DOI: 10.1016/j.josat.2022.208943] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/02/2022] [Revised: 09/02/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Given the personal and public consequences of untreated/undertreated OUD among persons involved in the justice system, an increasing number of jails and prisons are incorporating medication for opioid use disorder (MOUD) into their system. Estimating the costs of implementing and sustaining a particular MOUD program is vital to detention facilities, which typically face modest, fixed health care budgets. We developed a customizable budget impact tool to estimate the implementation and sustainment costs of numerous MOUD delivery models for detention facilities. METHODS The aim is to describe the tool and present an application of a hypothetical MOUD model. The tool is populated with resources required to implement and sustain various MOUD models in detention facilities. We identified resources via micro-costing techniques alongside randomized clinical trials. The resource-costing method is used to assign values to resources. Resources/costs are categorized as (a) fixed, (b) time-dependent, and (c) variable. Implementation costs include (a), (b), and (c) over a specified timeframe. Sustainment costs include (b) and (c). The MOUD model example entails offering all three FDA-approved medications, with methadone and buprenorphine provided by vendors, and naltrexone by the jail/prison facility. RESULTS Fixed resources/costs are incurred only once, including accreditation fees and trainings. Time-dependent resources/costs are recurring, but fixed over a given time-period; e.g., medication delivery and staff meetings. Variable resources/costs are those that are a direct function of the number of persons treated, such as the medication provided to each patient. Using nationally representative prices, we estimated fixed/sustainment costs to be $2919/patient, over 1 year. This article estimates annual sustainment costs to be $2885/patient. CONCLUSION The tool will serve as a valuable asset to jail/prison leadership, policymakers, and other stakeholders interested in identifying/estimating the resources and costs associated with alternative MOUD delivery models, from the planning stages through sustainment.
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Affiliation(s)
- Danielle A Ryan
- Weill Cornell Medical College, Department of Population Health Sciences, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America.
| | - Iván D Montoya
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 N.W. 14(th) Street, Suite 1024, Miami, FL 33136, United States of America
| | - Peter J Koutoujian
- Middlesex House of Corrections and Jail, 269 Treble Cove Rd., North Billerica, MA 01862, United States of America
| | - Kashif Siddiqi
- Middlesex House of Corrections and Jail, 269 Treble Cove Rd., North Billerica, MA 01862, United States of America
| | - Edmond Hayes
- Franklin County Jail, 160 Elm St., Greenfield, MA 01301, United States of America
| | - Philip J Jeng
- Weill Cornell Medical College, Department of Population Health Sciences, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
| | - Techna Cadet
- Weill Cornell Medical College, Department of Population Health Sciences, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
| | - Kathryn E McCollister
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 N.W. 14(th) Street, Suite 1024, Miami, FL 33136, United States of America
| | - Sean M Murphy
- Weill Cornell Medical College, Department of Population Health Sciences, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
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Murphy SM, Jeng PJ, McCollister KE, Leff JA, Jalali A, Shulman M, Lee JD, Nunes EV, Novo P, Rotrosen J, Schackman BR. Cost-effectiveness implications of increasing the efficiency of the extended-release naltrexone induction process for the treatment of opioid use disorder: a secondary analysis. Addiction 2021; 116:3444-3453. [PMID: 33950535 PMCID: PMC8568741 DOI: 10.1111/add.15531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 02/10/2020] [Revised: 07/13/2020] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS In a US randomized-effectiveness trial comparing extended-release naltrexone (XR-NTX) with buprenorphine-naloxone (BUP-NX) for the prevention of opioid relapse among participants recruited during inpatient detoxification (CTN-0051), the requirement to complete opioid detoxification prior to initiating XR-NTX resulted in lower rates of initiation of XR-NTX (72% XR-NTX versus 94% BUP-NX). DESIGN This was a retrospective secondary analysis of CTN-0051 trial data, including follow-up data over 24-36 weeks. SETTING Eight community-based, inpatient-detoxification and follow-up outpatient treatment facilities in the United States. PARTICIPANTS A total of 283 participants randomized to receive XR-NTX. MEASUREMENTS Efficiency was estimated using a multivariable generalized structural equation model to explore simultaneous determinants of XR-NTX induction and induction duration (detoxification + residential days). Cost-effectiveness was estimated from the health-care sector perspective and included expected costs and quality-adjusted life-years (QALYs). FINDINGS Treatment site was the only modifiable factor that simultaneously increased the likelihood of XR-NTX induction and decreased induction duration. Incorporating the higher predicted probability of XR-NTX induction, and fewer predicted days of detoxification and subsequent residential treatment into the cost-effectiveness framework, reduced the incremental average 24-week total cost of XR-NTX treatment from $5317 more than that of BUP-NX (P = 0.01) to a non-statistically-significant difference of $1016 (P = 0.63). QALYs gained remained similar across arms. CONCLUSION Adopting an efficient model of extended-release naltrexone initiation could result in extended-release naltrexone and buprenorphine-naloxone being of comparable economic value from the health-care sector perspective over 24-36 weeks for patients seeking treatment for opioid use disorder at an inpatient detoxification facility.
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Affiliation(s)
- Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell
Medical College, New York, NY, USA
| | - Philip J. Jeng
- Department of Population Health Sciences, Weill Cornell
Medical College, New York, NY, USA
| | - Kathryn E. McCollister
- Department of Public Health Sciences, University of Miami
Miller School of Medicine, Miami, FL USA
| | - Jared A. Leff
- Department of Population Health Sciences, Weill Cornell
Medical College, New York, NY, USA
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell
Medical College, New York, NY, USA
| | - Matisyahu Shulman
- New York State Psychiatric Institute, Columbia University
Medical Center, New York, NY USA
| | - Joshua D. Lee
- Department of Population Health, New York University School
of Medicine, New York, NY USA
| | - Edward V. Nunes
- New York State Psychiatric Institute, Columbia University
Medical Center, New York, NY USA
| | - Patricia Novo
- Department of Psychiatry, New York University School of
Medicine, New York, NY USA
| | - John Rotrosen
- Department of Psychiatry, New York University School of
Medicine, New York, NY USA
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell
Medical College, New York, NY, USA
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9
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Murphy SM, Laiteerapong N, Pho MT, Ryan D, Montoya I, Shireman TI, Huang E, McCollister KE. Health economic analyses of the justice community opioid innovation network (JCOIN). J Subst Abuse Treat 2021; 128:108262. [PMID: 33419602 PMCID: PMC8255321 DOI: 10.1016/j.jsat.2020.108262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/05/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 02/04/2023]
Abstract
The Justice Community Opioid Innovation Network (JCOIN) will generate real-world evidence to address the unique needs of people with opioid use disorder (OUD) in justice settings. Evidence regarding the economic value of OUD interventions in justice populations is limited. Moreover, the variation in economic study designs is a barrier to defining specific interventions as broadly cost-effective. The JCOIN Health Economics Analytic Team (HEAT) has worked closely with the Measures Committee to incorporate common economic measures and instruments across JCOIN studies, which will: a) ensure rigorous economic evaluations within each trial; b) enhance comparability of findings across studies; and c) allow for cross-study analyses of trials with similar designs/settings (e.g., pre-reentry MOUD), to assess questions beyond the scope of a single study, while controlling for and evaluating the effect of intervention-, organizational-, and population-level characteristics. We describe shared trial characteristics relevant to the economic evaluations, and discuss potential cross-study economic analyses.
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Affiliation(s)
- Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA.
| | | | - Mai T Pho
- University of Chicago, Chicago, IL, USA
| | - Danielle Ryan
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Iván Montoya
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Theresa I Shireman
- Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | | | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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10
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Onuoha EN, Leff JA, Schackman BR, McCollister KE, Polsky D, Murphy SM. Economic Evaluations of Pharmacologic Treatment for Opioid Use Disorder: A Systematic Literature Review. Value Health 2021; 24:1068-1083. [PMID: 34243831 PMCID: PMC8591614 DOI: 10.1016/j.jval.2020.12.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 11/15/2019] [Revised: 12/10/2020] [Accepted: 12/29/2020] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The crisis of opioid use puts a strain on resources in the United States and worldwide. There are 3 US Food and Drug Administration-approved medications for treatment of opioid use disorder: methadone, buprenorphine, and injectable extended-release naltrexone (XR-NTX). The comparative effectiveness and cost vary considerably among these 3 medications. Economic evaluations provide evidence that help stakeholders efficiently allocate scarce resources. Our objective was to summarize recent health economic evidence of pharmacologic treatment of opioid use disorder interventions. METHODS We searched PubMed for peer-reviewed studies in English from August 2015 through December 2019 as an update to a 2015 review. We used the Drummond checklist to evaluate and categorize economic evaluation study quality. We summarized results by economic evaluation methodology and pharmacologic treatment modality. RESULTS We identified 105 articles as potentially relevant and included 21 (4 cost-offset studies and 17 cost-effectiveness/cost-benefit studies). We found strengthened evidence on buprenorphine and methadone, indicating that these treatments are economically advantageous compared with no pharmacotherapy, but found limited evidence on XR-NTX. Only half of the cost-effectiveness studies used a generic preference-based measure of effectiveness, limiting broad comparison across diseases/disorders. The disease/disorder-specific cost-effectiveness measures vary widely, suggesting a lack of consensus on the value of substance use disorder treatment. CONCLUSION We found studies that provide new evidence supporting the cost-effectiveness of buprenorphine compared with no pharmacotherapy. We found a lack of evidence supporting superior economic value for buprenorphine versus methadone, suggesting that both are attractive alternatives. Further economic research is needed on XR-NTX, as well as other emerging pharmacotherapies, treatment modalities, and dosage forms.
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Affiliation(s)
- Erica N Onuoha
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA.
| | - Jared A Leff
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel Polsky
- Johns Hopkins Carey Business School, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sean M Murphy
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Bowser DM, Henry BF, McCollister KE. Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review. Implement Sci 2021; 16:26. [PMID: 33706780 PMCID: PMC7953634 DOI: 10.1186/s13012-021-01094-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study is a systematic literature review of cost analyses conducted within implementation studies on behavioral health services. Cost analysis of implementing evidence-based practices (EBP) has become important within implementation science and is critical for bridging the research to practice gap to improve access to quality healthcare services. Costing studies in this area are rare but necessary since cost can be a barrier to implementation and sustainment of EBP. Methods We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and applied the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Key search terms included: (1) economics, (2) implementation, (3) EBP, and (4) behavioral health. Terms were searched within article title and abstracts in: EconLit, SocINDEX, Medline, and PsychINFO. A total of 464 abstracts were screened independently by two authors and reduced to 37 articles using inclusion and exclusion criteria. After a full-text review, 18 articles were included. Results Findings were used to classify costs into direct implementation, direct services, and indirect implementation. While all studies included phases of implementation as part of their design, only five studies examined resources across multiple phases of an implementation framework. Most studies reported direct service costs associated with adopting a new practice, usually summarized as total EBP cost, cost per client, cost per clinician, and/or cost per agency. For studies with detailed analysis, there were eleven direct cost categories represented. For five studies that reported costs per child served, direct implementation costs varied from $886 to $9470 per child, while indirect implementation costs ranged from $897 to $3805 per child. Conclusions This is the first systematic literature review to examine costs of implementing EBP in behavioral healthcare settings. Since 2000, 18 studies were identified that included a cost analysis. Given a wide variation in the study designs and economic methods, comparison across studies was challenging, which is a major limitation in the field, as it becomes difficult to replicate studies or to estimate future costs to inform policy decisions related to budgeting. We recommend future economic implementation studies to consider standard economic costing methods capturing costs across implementation framework phases to support comparisons and replicability.
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Affiliation(s)
- Diana M Bowser
- Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA
| | - Brandy F Henry
- Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA. .,School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA.
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., CRB 1019, Miami, FL, 33136, USA
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13
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Zheng DD, Loewenstein DA, Christ SL, Feaster DJ, Lam BL, McCollister KE, Curiel-Cid RE, Lee DJ. Multimorbidity patterns and their relationship to mortality in the US older adult population. PLoS One 2021; 16:e0245053. [PMID: 33471812 PMCID: PMC7816983 DOI: 10.1371/journal.pone.0245053] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/21/2020] [Indexed: 01/12/2023] Open
Abstract
Background Understanding patterns of multimorbidity in the US older adult population and their relationship with mortality is important for reducing healthcare utilization and improving health. Previous investigations measured multimorbidity as counts of conditions rather than specific combination of conditions. Methods This cross-sectional study with longitudinal mortality follow-up employed latent class analysis (LCA) to develop clinically meaningful subgroups of participants aged 50 and older with different combinations of 13 chronic conditions from the National Health Interview Survey 2002–2014. Mortality linkage with National Death Index was performed through December 2015 for 166,126 participants. Survival analyses were conducted to assess the relationships between LCA classes and all-cause mortality and cause specific mortalities. Results LCA identified five multimorbidity groups with primary characteristics: “healthy” (51.5%), “age-associated chronic conditions” (33.6%), “respiratory conditions” (7.3%), “cognitively impaired” (4.3%) and “complex cardiometabolic” (3.2%). Covariate-adjusted survival analysis indicated “complex cardiometabolic” class had the highest mortality with a Hazard Ratio (HR) of 5.30, 99.5% CI [4.52, 6.22]; followed by “cognitively impaired” class (3.34 [2.93, 3.81]); “respiratory condition” class (2.14 [1.87, 2.46]); and “age-associated chronic conditions” class (1.81 [1.66, 1.98]). Patterns of multimorbidity classes were strongly associated with the primary underlying cause of death. The “cognitively impaired” class reported similar number of conditions compared to the “respiratory condition” class but had significantly higher mortality (3.8 vs 3.7 conditions, HR = 1.56 [1.32, 1.85]). Conclusion We demonstrated that LCA method is effective in classifying clinically meaningful multimorbidity subgroup. Specific combinations of conditions including cognitive impairment and depressive symptoms have a substantial detrimental impact on the mortality of older adults. The numbers of chronic conditions experienced by older adults is not always proportional to mortality risk. Our findings provide valuable information for identifying high risk older adults with multimorbidity to facilitate early intervention to treat chronic conditions and reduce mortality.
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Affiliation(s)
- D. Diane Zheng
- Department of Psychiatry and Behavioral Science, Center for Cognitive Neurosciences & Aging, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
| | - David A. Loewenstein
- Department of Psychiatry and Behavioral Science, Center for Cognitive Neurosciences & Aging, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Sharon L. Christ
- Department of Human Development and Family Studies and Statistics, Purdue University, West Lafayette, Indiana, United States of America
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Byron L. Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Kathryn E. McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Rosie E. Curiel-Cid
- Department of Psychiatry and Behavioral Science, Center for Cognitive Neurosciences & Aging, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - David J. Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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14
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Evans EA, Stopka TJ, Pivovarova E, Murphy SM, Taxman FS, Ferguson WJ, Bernson D, Santelices C, McCollister KE, Hoskinson R, Lincoln T, Friedmann PD. Massachusetts Justice Community Opioid Innovation Network (MassJCOIN). J Subst Abuse Treat 2021; 128:108275. [PMID: 33483222 DOI: 10.1016/j.jsat.2021.108275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/09/2020] [Accepted: 01/02/2021] [Indexed: 12/30/2022]
Abstract
A major driver of the U.S. opioid crisis is limited access to effective medications for opioid use disorder (MOUD) that reduce overdose risks. Traditionally, jails and prisons in the U.S. have not initiated or maintained MOUD for incarcerated individuals with OUD prior to their return to the community, which places them at high risk for fatal overdose. A 2018 law (Chapter 208) made Massachusetts (MA) the first state to mandate that five county jails deliver all FDA-approved MOUDs (naltrexone [NTX], buprenorphine [BUP], and methadone). Chapter 208 established a 4-year pilot program to expand access to all FDA-approved forms of MOUD at five jails, with two more MA jails voluntarily joining this initiative. The law stipulates that MOUD be continued for individuals receiving it prior to detention and be initiated prior to release among sentenced individuals where appropriate. The jails must also facilitate continuation of MOUD in the community on release. The Massachusetts Justice Community Opioid Innovation Network (MassJCOIN) partnered with these seven diverse jails, the MA Department of Public Health, and community treatment providers to conduct a Type 1 hybrid effectiveness-implementation study of Chapter 208. We will: (1) Perform a longitudinal treatment outcome study among incarcerated individuals with OUD who receive NTX, BUP, methadone, or no MOUD in jail to examine postrelease MOUD initiation, engagement, and retention, as well as fatal and nonfatal opioid overdose and recidivism; (2) Conduct an implementation study to understand systemic and contextual factors that facilitate and impede delivery of MOUDs in jail and community care coordination, and strategies that optimize MOUD delivery in jail and for coordinating care with community partners; (3) Calculate the cost to the correctional system of implementing MOUD in jail, and conduct an economic evaluation from state policy-maker and societal perspectives to compare the value of MOUD prior to release from jail to no MOUD among matched controls. MassJCOIN made significant progress during its first six months until the COVID-19 pandemic began in March 2020. Participating jail sites restricted access for nonessential personnel, established other COVID-19 mitigation policies, and modified MOUD programming. MassJCOIN adapted research activities to this new reality in an effort to document and account for the impacts of COVID-19 in relation to each aim. The goal remains to produce findings with direct implications for policy and practice for OUD in criminal justice settings.
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Affiliation(s)
- Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA 01003, United States of America.
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, United States of America
| | - Ekaterina Pivovarova
- Department of Psychiatry, University of Massachusetts Medical School and Massachusetts Center of Excellence for Specialty Courts, Worcester, MA, United States of America; Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States of America
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY, United States of America.
| | - Faye S Taxman
- Center for Advancing Correctional Excellence, George Mason University, 4087 University Drive, 4100, MSN6D3, Fairfax, VA 22030, United States of America
| | - Warren J Ferguson
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States of America.
| | - Dana Bernson
- Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108, United States of America
| | - Claudia Santelices
- Urban Health Research and Practice, Northeastern University, Boston, MA, United States of America
| | - Kathryn E McCollister
- Soffer Clinical Research Center, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14(th) Street, Suite 1019, Miami, FL 33136, United States of America.
| | - Randall Hoskinson
- University of Massachusetts Medical School - Baystate, Springfield, MA, United States of America
| | - Thomas Lincoln
- University of Massachusetts Medical School - Baystate, Springfield, MA, United States of America
| | - Peter D Friedmann
- University of Massachusetts Medical School - Baystate, Springfield, MA, United States of America.
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15
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Walsh SL, El-Bassel N, Jackson RD, Samet JH, Aggarwal M, Aldridge AP, Baker T, Barbosa C, Barocas JA, Battaglia TA, Beers D, Bernson D, Bowers-Sword R, Bridden C, Brown JL, Bush HM, Bush JL, Button A, Campbell AN, Cerda M, Cheng DM, Chhatwal J, Clarke T, Conway KP, Crable EL, Czajkowski A, David JL, Drainoni ML, Fanucchi LC, Feaster DJ, Fernandez S, Freedman D, Freisthler B, Gilbert L, Glasgow LM, Goddard-Eckrich D, Gutnick D, Harlow K, Helme DW, Huang T, Huerta TR, Hunt T, Hyder A, Kerner R, Keyes K, Knott CE, Knudsen HK, Konstan M, Larochelle MR, Craig Lefebvre R, Levin F, Lewis N, Linas BP, Lofwall MR, Lounsbury D, Lyons MS, Mann S, Marks KR, McAlearney A, McCollister KE, McCrimmon T, Miles J, Miller CC, Nash D, Nunes E, Oga EA, Oser CB, Plouck T, Rapkin B, Freeman PR, Rodriguez S, Root E, Rosen-Metsch L, Sabounchi N, Saitz R, Salsberry P, Savitsky C, Schackman BR, Seiber EE, Slater MD, Slavova S, Speer D, Martinez LS, Stambaugh LF, Staton M, Stein MD, Stevens-Watkins DJ, Surratt HL, Talbert JC, Thompson KL, Toussant K, Vandergrift NA, Villani J, Walker DM, Walley AY, Walters ST, Westgate PM, Winhusen T, Wu E, Young AM, Young G, Zarkin GA, Chandler RK. The HEALing (Helping to End Addiction Long-term SM) Communities Study: Protocol for a cluster randomized trial at the community level to reduce opioid overdose deaths through implementation of an integrated set of evidence-based practices. Drug Alcohol Depend 2020; 217:108335. [PMID: 33248391 PMCID: PMC7568493 DOI: 10.1016/j.drugalcdep.2020.108335] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Opioid overdose deaths remain high in the U.S. Despite having effective interventions to prevent overdose deaths, there are numerous barriers that impede their adoption. The primary aim of the HEALing Communities Study (HCS) is to determine the impact of an intervention consisting of community-engaged, data-driven selection, and implementation of an integrated set of evidence-based practices (EBPs) on reducing opioid overdose deaths. METHODS The HCS is a four year multi-site, parallel-group, cluster randomized wait-list controlled trial. Communities (n = 67) in Kentucky, Massachusetts, New York and Ohio are randomized to active intervention (Wave 1), which starts the intervention in Year 1 or the wait-list control (Wave 2), which starts the intervention in Year 3. The HCS will test a conceptually driven framework to assist communities in selecting and adopting EBPs with three components: 1) a community engagement strategy with local coalitions to guide and implement the intervention; 2) a compendium of EBPs coupled with technical assistance; and 3) a series of communication campaigns to increase awareness and demand for EBPs and reduce stigma. An implementation science framework guides the intervention and allows for examination of the multilevel contexts that promote or impede adoption and expansion of EBPs. The primary outcome, number of opioid overdose deaths, will be compared between Wave 1 and Wave 2 communities during Year 2 of the intervention for Wave 1. Numerous secondary outcomes will be examined. DISCUSSION The HCS is the largest community-based implementation study in the field of addiction with an ambitious goal of significantly reducing fatal opioid overdoses.
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16
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Zheng DD, McCollister KE, Christ SL, Lam BL, Feaster DJ, Lee DJ. Chronic condition patterns in the US population and their association with health related quality of life. Prev Med 2020; 136:106102. [PMID: 32360766 PMCID: PMC10619464 DOI: 10.1016/j.ypmed.2020.106102] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 11/01/2019] [Revised: 02/28/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022]
Abstract
This study aims to identify chronic disease patterns and their relationship to health-related quality of life (HRQL) in the US population. This cross-sectional study used data from 86,745 participants aged 18 years and older of the Medical Expenditure Panel Survey (MEPS) 2010-2015, we employed latent class analysis (LCA) to identify subgroups of participants with different combinations of 23 chronic conditions which had medical utilization during the past 12 months. Derived chronic condition latent classes were used to predict the 12-Item Short Form Survey physical component score (PCS), mental component score (MCS) in addition to overall HRQL (SF-6D) while controlling for covariates. LCA identified five unique multi-morbidity groups: "healthy" (62.5%), "vascular risk" (18.9%), "anxiety" (12.2%), "heart disease" (2.9%), and "severely-impaired" (3.5%). Covariate-adjusted mean SF-6D scores varied significantly among classes: healthy (0.85), vascular risk (0.77), anxiety (0.67), heart disease group (0.65), and severely-impaired (0.56). The anxiety group, proportionately younger and female, had high PCS (46.3) but low MCS (41.9). The heart disease group, although older and in poor physical health (PCS = 33.2), had higher MCS scores (46.9). Our results demonstrate multi-morbidity significantly impacts HRQL. The relationship between physical and mental health functioning varied across different multi-morbidity groups, and the discordance was more pronounced in younger ages and females. Our research also identified an older age group that was mentally robust and maintained a strong HRQL. Findings can inform the development of targeted interventions to improve physical and mental health functioning in vulnerable populations.
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Affiliation(s)
- D Diane Zheng
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America.
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Sharon L Christ
- Department of Human Development and Family Studies and Statistics, Purdue University, West Lafayette, IN, United States of America
| | - Byron L Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
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17
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Jalali A, Ryan DA, McCollister KE, Marsch LA, Schackman BR, Murphy SM. Economic evaluation in the National Drug Abuse Treatment Clinical Trials Network: Past, present, and future. J Subst Abuse Treat 2020; 112S:18-27. [PMID: 32220406 DOI: 10.1016/j.jsat.2020.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 01/01/2023]
Abstract
Economic evaluations provide evidence that informs stakeholders on how to efficiently allocate real and financial healthcare resources. The purpose of this study was to review and discuss the integration of economic evaluations into the National Drug Abuse Treatment Clinical Trials Network (CTN) since its inception, as well as expectations for the future of this relationship. A systematic review was performed on published and planned CTN economic evaluations in the CTN dissemination library and PubMed. The well-established Drummond checklist was used to evaluate the comprehensiveness and methodological rigor of published articles. One hundred thirty-eight ancillary, follow-up, or original protocols were reviewed, and 78 potentially relevant published articles were identified. A total number of 14 protocols included an economic evaluation. Of these, 6 protocols were completed, 2 were reported as active, and 6 were reported as in-development at the time of this review. Of the 78 published articles, 9 met the inclusion criteria. As gauged by the Drummond checklist, the quality of CTN published economic evaluations were found to improve over time, and recent published articles were identified as guides to cutting-edge economic research. As the CTN continues to grow and mature, it is imperative that high-quality economic evaluations are incorporated alongside trials in order to maximize the public health impact of the CTN.
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Affiliation(s)
- Ali Jalali
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA.
| | - Danielle A Ryan
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
| | - Sean M Murphy
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
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Bowser D, Henry BF, McCollister KE. An Overlapping Systems Conceptual Framework to Evaluate Implementation of a Behavioral Health Intervention for Justice-Involved Youth. Health Serv Insights 2019; 12:1178632919855037. [PMID: 31244523 PMCID: PMC6582281 DOI: 10.1177/1178632919855037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/12/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Nearly 65% of justice–involved youth have a substance use and/or mental health disorder. Although evidence–based practices have been established for adolescents with co–occurring mental health and substance use disorders, these practices are not widely used in juvenile justice agencies due to environmental and organizational complexities. Methods: Our study builds on Juvenile Justice—Translational Research on Interventions for Adolescents in the Legal System (JJ–TRIALS), a multi–site cooperative research initiative of juvenile justice and partnering behavioral health agencies. We also integrate state and county–level data to support broader assessment of key drivers of implementation success. Results: We present an economics/systems conceptual model describing how the environmental context, systems organization, and economic costs of implementation can affect implementation outcomes. Comparison of intervention condition (Core vs Enhanced) and pre–implementation costs (High vs Low) found differences in insurance reimbursements and types, as well as agency staffing characteristics. Discussion: Implementing new procedures or policies at a systems level must consider implementation outcomes in a broad context. Factors such as population demographics, primary care and behavioral health treatment capacity, unemployment rates, and public funding for treatment and other services are important in determining intervention success and sustainability.
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Affiliation(s)
- Diana Bowser
- Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Brandy F Henry
- Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Kathryn E McCollister
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
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Reckers-Droog VT, Goorden M, Dijkgraaf MGW, Van Eeren HV, McCollister KE, Hakkaart-van Roijen L. Unit Costs of Delinquent Acts for Use in Economic Evaluations. J Ment Health Policy Econ 2019; 22:71-79. [PMID: 31319377 PMCID: PMC6839943] [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] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Youth mental health interventions aimed at reducing substance use and delinquency in adolescents compete with other types of interventions for reimbursement from public funding. Within the youth mental health domain, delinquent acts impose high costs on society. These costs should be included in economic evaluations conducted from a societal perspective. Although the relevance of these costs is recognized, they are often left out because the unit costs of delinquent acts are unknown. AIMS OF THE STUDY This study aims to provide a method for estimating the unit costs per perpetrator of 14 delinquent acts common in the Netherlands and included in self reported delinquency questionnaires: robbery/theft with violence, simple theft/pickpocketing, receiving stolen goods, destruction/vandalism of private or public property, disorderly conduct/discrimination, arson, cybercrime, simple and aggravated assault, threat, forced sexual contact, unauthorised driving, driving under the influence, dealing in soft drugs, and dealing in hard drugs. METHODS Information on government expenditures and the incidence of crimes, number of perpetrators, and the percentage of solved and reported crimes was obtained from the national database on crime and justice of the Research and Documentation Centre of the Ministry of Justice and Security, Statistics Netherlands, and the Council for the Judiciary in the Netherlands. We applied a top-down micro costing approach to calculate the point estimate of the unit costs for each of the delinquent acts and, subsequently, estimated the mean (SD) unit costs for each of the delinquent acts by taking random draws from a triangular distribution while taking into account a 10% uncertainty associated with the associated point estimate. RESULTS The mean (SD) unit costs per delinquent act per perpetrator ranged between EUR495 (EUR1.30) for "Driving under the influence" and EUR33,813 (EUR78.30) for a "Cybercrime". These unit costs may be considered as outliers as most unit costs ranged between EUR 2,600 and EUR 13,500 per delinquent act per perpetrator. DISCUSSION This study is the first to estimate the unit costs per delinquent act per perpetrator in the Netherlands. The results of this study enable the inclusion of government expenditures associated with crime and justice in economic evaluations conducted from a societal perspective. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE Youth mental health interventions aimed at reducing substance use and delinquency in adolescents are increasingly subjected to economic evaluations. These evaluations are used to inform decisions concerning the allocation of scarce healthcare resources and should cover all the costs and benefits for society, including those associated with delinquent acts. IMPLICATIONS FOR HEALTH POLICIES The results of this study facilitate economic evaluations of youth mental health interventions aimed at reducing substance use and delinquency in adolescents, conducted from a societal perspective. IMPLICATIONS FOR FURTHER RESEARCH Based on health-economic evaluations conducted in the field of youth mental health and the results of the current study, we recommend including the estimated unit costs in guidelines for health-economic evaluations conducted from a societal perspective. Future research could aim at examining whether these unit costs require regular updating. The methodology applied in this study allows for this.
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Affiliation(s)
- Vivian T Reckers-Droog
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands,
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Murphy SM, McCollister KE, Leff JA, Yang X, Jeng PJ, Lee JD, Nunes EV, Novo P, Rotrosen J, Schackman BR. Cost-Effectiveness of Buprenorphine-Naloxone Versus Extended-Release Naltrexone to Prevent Opioid Relapse. Ann Intern Med 2019; 170:90-98. [PMID: 30557443 PMCID: PMC6581635 DOI: 10.7326/m18-0227] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 02/08/2023] Open
Abstract
BACKGROUND Not enough evidence exists to compare buprenorphine-naloxone with extended-release naltrexone for treating opioid use disorder. OBJECTIVE To evaluate the cost-effectiveness of buprenorphine-naloxone versus extended-release naltrexone. DESIGN Cost-effectiveness analysis alongside a previously reported randomized clinical trial of 570 adults in 8 U.S. inpatient or residential treatment programs. DATA SOURCES Study instruments. TARGET POPULATION Adults with opioid use disorder. TIME HORIZON 24-week intervention with an additional 12 weeks of observation. PERSPECTIVE Health care sector and societal. INTERVENTIONS Buprenorphine-naloxone and extended-release naltrexone. OUTCOME MEASURES Incremental costs combined with incremental quality-adjusted life-years (QALYs) and incremental time abstinent from opioids. RESULTS OF BASE-CASE ANALYSIS Use of the health care sector perspective and a willingness-to-pay threshold of $100 000 per QALY showed buprenorphine-naloxone to be preferable to extended-release naltrexone in 97% of bootstrap replications at 24 weeks and in 85% at 36 weeks. Similar results were obtained with incremental time abstinent from opioids as an outcome and with use of the societal perspective. RESULTS OF SENSITIVITY ANALYSIS The base-case results were sensitive to the cost of the 2 treatments and the success of randomized treatment initiation. LIMITATION Relatively short follow-up for a chronic condition, substantial missing data, no information on patient out-of-pocket and social service costs. CONCLUSION Buprenorphine-naloxone is preferred to extended-release naltrexone as first-line treatment when both options are clinically appropriate and patients require detoxification before initiating extended-release naltrexone. PRIMARY FUNDING SOURCE National Institute on Drug Abuse, National Institutes of Health.
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Affiliation(s)
- Sean M Murphy
- Weill Cornell Medical College, New York, New York (S.M.M., J.A.L., P.J.J., B.R.S.)
| | | | - Jared A Leff
- Weill Cornell Medical College, New York, New York (S.M.M., J.A.L., P.J.J., B.R.S.)
| | - Xuan Yang
- University of Miami Miller School of Medicine, Miami, Florida (K.E.M., X.Y.)
| | - Philip J Jeng
- Weill Cornell Medical College, New York, New York (S.M.M., J.A.L., P.J.J., B.R.S.)
| | - Joshua D Lee
- New York University School of Medicine, New York, New York (J.D.L., P.N., J.R.)
| | - Edward V Nunes
- Columbia University Medical Center, New York, New York (E.V.N.)
| | - Patricia Novo
- New York University School of Medicine, New York, New York (J.D.L., P.N., J.R.)
| | - John Rotrosen
- New York University School of Medicine, New York, New York (J.D.L., P.N., J.R.)
| | - Bruce R Schackman
- Weill Cornell Medical College, New York, New York (S.M.M., J.A.L., P.J.J., B.R.S.)
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McCollister KE, Leff JA, Yang X, Lee JD, Nunes EV, Novo P, Rotrosen J, Schackman BR, Murphy SM. Cost of pharmacotherapy for opioid use disorders following inpatient detoxification. Am J Manag Care 2018; 24:526-531. [PMID: 30452209 PMCID: PMC6345513] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To estimate the costs of providing extended-release injectable naltrexone (XR-NTX) and buprenorphine-naloxone (BUP-NX) following inpatient detoxification using data derived from a multisite randomized controlled trial at 8 US community-based treatment programs. STUDY DESIGN Cost data were collected for 3 intervention phases: program start-up, inpatient detoxification, and up to 24 weeks of medication induction and management visits (post detoxification). Cost analyses were from the healthcare sector perspective (2015 US$); patient costs are also reported. METHODS We conducted site visits, administered a cost survey to treatment programs, and analyzed study data on medication and services utilization. Nationally representative sources were used to estimate unit costs. Uncertainty was evaluated in sensitivity analyses. RESULTS Mean start-up costs were $1071 per program for XR-NTX and $828 per program for BUP-NX. Mean costs per participant were $5416 for XR-NTX (57% detoxification, 37% medication, 3% provider, 3% patient) and $4148 for BUP-NX (64% detoxification, 12% medication, 10% provider, 14% patient). Total cost per participant ranged by site from $2979 to $8963 for XR-NTX and from $2521 to $6486 for BUP-NX. CONCLUSIONS For treatment providers, offering XR-NTX and/or BUP-NX as part of existing detoxification treatment modalities generates modest costs in addition to the costs of detoxification, which vary substantially among the 8 sites. From the patient's perspective, the costs associated with medication management visits may be a barrier for some individuals considering these treatments.
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Affiliation(s)
- Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Soffer Clinical Research Center, Ste 1019, 1120 NW 14th St, Miami, FL 33136.
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Peterson C, Kearns MC, McIntosh WL, Estefan LF, Nicolaidis C, McCollister KE, Gordon A, Florence C. Lifetime Economic Burden of Intimate Partner Violence Among U.S. Adults. Am J Prev Med 2018; 55:433-444. [PMID: 30166082 PMCID: PMC6161830 DOI: 10.1016/j.amepre.2018.04.049] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/04/2018] [Accepted: 04/17/2018] [Indexed: 01/12/2023]
Abstract
INTRODUCTION This study estimated the U.S. lifetime per-victim cost and economic burden of intimate partner violence. METHODS Data from previous studies were combined with 2012 U.S. National Intimate Partner and Sexual Violence Survey data in a mathematical model. Intimate partner violence was defined as contact sexual violence, physical violence, or stalking victimization with related impact (e.g., missed work days). Costs included attributable impaired health, lost productivity, and criminal justice costs from the societal perspective. Mean age at first victimization was assessed as 25 years. Future costs were discounted by 3%. The main outcome measures were the mean per-victim (female and male) and total population (or economic burden) lifetime cost of intimate partner violence. Secondary outcome measures were marginal outcome probabilities among victims (e.g., anxiety disorder) and associated costs. Analysis was conducted in 2017. RESULTS The estimated intimate partner violence lifetime cost was $103,767 per female victim and $23,414 per male victim, or a population economic burden of nearly $3.6 trillion (2014 US$) over victims' lifetimes, based on 43 million U.S. adults with victimization history. This estimate included $2.1 trillion (59% of total) in medical costs, $1.3 trillion (37%) in lost productivity among victims and perpetrators, $73 billion (2%) in criminal justice activities, and $62 billion (2%) in other costs, including victim property loss or damage. Government sources pay an estimated $1.3 trillion (37%) of the lifetime economic burden. CONCLUSIONS Preventing intimate partner violence is possible and could avoid substantial costs. These findings can inform the potential benefit of prioritizing prevention, as well as evaluation of implemented prevention strategies.
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Affiliation(s)
- Cora Peterson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Megan C Kearns
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wendy LiKamWa McIntosh
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lianne Fuino Estefan
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Amy Gordon
- School of Social Work, Portland State University, Portland, Oregon; and
| | - Curtis Florence
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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McCollister KE, Yang X, Murphy SM, Leff JA, Kronmal RA, Crane HM, Chandler RK, Taxman FS, Feaster DJ, Metsch LR, Cunningham WE, Altice FL, Schackman BR. Criminal justice measures for economic data harmonization in substance use disorder research. Health Justice 2018; 6:17. [PMID: 30242561 PMCID: PMC6755573 DOI: 10.1186/s40352-018-0073-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/29/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The consequences of substance use disorders (SUDs) are varied and broad, affecting many sectors of society and the economy. Economic evaluation translates these consequences into dollars to examine the net economic impact of interventions for SUD, and associated conditions such as HCV and HIV. The nexus between substance use and crime makes criminal justice outcomes particularly significant for estimating the economic impact of SUD interventions, and important for data harmonization. METHODS We compared baseline data collected in six NIDA-funded Seek, Test, Treat and Retain (STTR) intervention studies that enrolled HIV-infected/at-risk individuals with SUDs (total n = 3415). Criminal justice measures included contacts with the criminal justice system (e.g., arrests) and criminal offenses. The objective was to develop a list of recommended measures and methods supporting economic data harmonization opportunities in HIV and SUD research, with an initial focus on crime-related outcomes. RESULTS Criminal justice contacts and criminal offenses were highly variable across studies. When measures grouped by offense classifications were compared, consistencies across studies emerged. Most individuals report being arrested for property or public order crimes (> 50%); the most commonly reported offenses were prostitution/pimping, larceny/shoplifting, robbery, and household burglary. CONCLUSIONS We identified four measures that are feasible and appropriate for estimating the economic consequences of SUDs/HIV/HCV: number of arrests, number of convictions, days of incarceration, and times committing criminal offenses, by type of offense. To account for extreme variation, grouping crimes by offense classification or calculating monthly averages per event allows for more meaningful comparisons across studies.
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Affiliation(s)
- Kathryn E. McCollister
- Department Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Xuan Yang
- Department Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Sean M. Murphy
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY USA
| | - Jared A. Leff
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY USA
| | - Richard A. Kronmal
- Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA USA
| | - Heidi M. Crane
- Center for AIDS Research, University of Washington, Seattle, WA USA
| | | | - Faye S. Taxman
- Center for Advancing Correctional Excellence, George Mason University, Fairfax, VA USA
| | - Daniel J. Feaster
- Department Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY USA
| | | | - Frederick L. Altice
- Yale AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT USA
| | - Bruce R. Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY USA
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Hartzler B, Lyon AR, Walker DD, Matthews L, King KM, McCollister KE. Implementing the teen marijuana check-up in schools-a study protocol. Implement Sci 2017; 12:103. [PMID: 28797270 PMCID: PMC5553739 DOI: 10.1186/s13012-017-0633-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance misuse is now encountered in settings beyond addiction specialty care, with schools a point-of-contact for student access to behavioral health services. Marijuana is a leading impetus for adolescent treatment admissions despite declining risk perception, for which the Teen Marijuana Check-Up (TMCU)-a tailored adaptation of motivational enhancement therapy-offers an efficacious service option. To bridge the knowledge gap concerning effective and affordable technical assistance strategies for implementing empirically supported services, the described trial will test such a strategy to facilitate school-based TMCU implementation. METHODS A type II effectiveness/implementation hybrid trial will test a novel strategy for a TMCU purveyor to provide technical assistance on an 'as-needed' basis when triggered by a fidelity drift alarm bell, compared to resource-intensive 'gold-standard' technical assistance procedures of prior efficacy trials. Trial procedures adhere to the EPIS framework as follows: (1) initial mixed-method exploration of the involved school contexts and identification of TMCU interventionist candidates in elicitation interviews; (2) interventionist preparation via a formally evaluated training process involving a two-day workshop and sequence of three training cases; (3) post-training implementation for 24 months for which trained interventionists are randomized to 'as-needed' or 'gold-standard' technical assistance and self-referring students randomized (in 2:1 ratio) to TMCU or waitlist/control; and (4) examination of TMCU sustainment via interventionist completion of biannual outcome assessments, cost analyses, and exit interviews. Hypothesized effects include non-differential influence of the competing technical assistance methods on both TMCU fidelity and intervention effectiveness, with lesser school costs for the 'as-needed' than 'gold-standard' technical assistance and greater reduction in the frequency of marijuana use expected among TMCU-exposed students relative to those assigned to waitlist/control. DISCUSSION This trial-occurring in Washington state as legislative, fiscal, and sociocultural forces converge to heighten exposure of American adolescents to marijuana-related harms-is set to advance understanding of best implementation practices for this and other efficacious, school-based interventions through examination of a data-driven technical assistance method. If shown to be clinically useful and affordable, the concept of a fidelity drift alarm could be readily translated to other empirically supported services and in other health settings. TRIAL REGISTRATION ClinicalTrials.gov NCT03111667 registered 7 April 2017.
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Affiliation(s)
- Bryan Hartzler
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105, USA.
| | - Aaron R Lyon
- Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98105, USA
| | - Denise D Walker
- School of Social Work, University of Washington, 909 NE 43rd Street, Suite 304, Seattle, WA, 98105, USA
| | - Lauren Matthews
- School of Social Work, University of Washington, 909 NE 43rd Street, Suite 304, Seattle, WA, 98105, USA
| | - Kevin M King
- Department of Psychology, University of Washington, 119A Guthrie Hall, Seattle, WA, 98195, USA
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1019, Miami, FL, 33136, USA
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Moon CS, Nanji AA, Galor A, McCollister KE, Karp CL. Surgical versus Medical Treatment of Ocular Surface Squamous Neoplasia: A Cost Comparison. Ophthalmology 2015; 123:497-504. [PMID: 26686965 DOI: 10.1016/j.ophtha.2015.10.043] [Citation(s) in RCA: 21] [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] [Received: 07/04/2015] [Revised: 10/26/2015] [Accepted: 10/26/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The objective of this study was to compare the cost associated with surgical versus interferon-alpha 2b (IFNα2b) treatment for ocular surface squamous neoplasia (OSSN). DESIGN A matched, case-control study. PARTICIPANTS A total of 98 patients with OSSN, 49 of whom were treated surgically and 49 of whom were treated medically. METHODS Patients with OSSN treated with IFNα2b were matched to patients treated with surgery on the basis of age and date of treatment initiation. Financial cost to the patient was calculated using 2 different methods (hospital billing and Medicare allowable charges) and compared between the 2 groups. These fees included physician fees (clinic, pathology, anesthesia, and surgery), facility fees (clinic, pathology, and operating room), and medication costs. Time invested by patients was calculated in terms of number of visits to the hospital and compared between the 2 groups. Parking costs, transportation, caregiver wages, and lost wages were not considered in our analysis. MAIN OUTCOME MEASURES Number of clinic visits and cost of therapy as represented by both hospital charges and Medicare allowable charges. RESULTS When considering cost in terms of time, the medical group had an average of 2 more visits over 1 year compared with the surgical group. Cost as represented by hospital charges was higher in the surgical group (mean, $17 598; standard deviation [SD], $7624) when compared with the IFNα2b group (mean, $4986; SD, $2040). However, cost between the 2 groups was comparable when calculated on the basis of Medicare allowable charges (surgical group: mean, $3528; SD, $1610; medical group: mean, $2831; SD, $1082; P = 1.00). The highest cost in the surgical group was the excisional biopsy (hospital billing $17 598; Medicare allowable $3528), and the highest cost in the medical group was interferon ($1172 for drops, average 8.0 bottles; $370 for injections, average 5.4 injections). CONCLUSIONS Our data in this group of patients previously demonstrated equal efficacy of surgical versus medical treatment. In this article, we consider costs of therapy and found that medical treatment involved two more office visits, whereas surgical treatment could be more or equally costly depending on insurance coverage.
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Affiliation(s)
- Christina S Moon
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Afshan A Nanji
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida; Miami Veterans Affairs Medical Center, Miami, Florida
| | | | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
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Galor A, Diane Zheng D, Arheart KL, Lam BL, McCollister KE, Ocasio MA, Fernandez CA, Lee DJ. Influence of socio-demographic characteristics on eye care expenditure: data from the Medical Expenditure Panel Survey 2007. Ophthalmic Epidemiol 2015; 22:28-33. [PMID: 23662909 PMCID: PMC11015530 DOI: 10.3109/09286586.2013.783081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 12/27/2011] [Revised: 09/07/2012] [Accepted: 12/11/2012] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the association between sociodemographic factors and eye care expenditure and to assess the burden of ocular expenditure compared to total health care expenditure. METHODS A retrospective analysis of ocular expenditure in participants of the 2007 Medical Expenditure Panel Survey. Data from 20,620 unique participants aged ≥18 years were evaluated for eye care expenditure by demographic characteristics. RESULTS A total of 22% of the studied population had eye care expenditures in 2007. Demographic factors significantly associated with higher probability of having eye care expenditures included older age (65+ years 35%, 45-64 years 23%, <45 years 17%), female sex (female 26%, male 19%), higher educational attainment (greater than high school education 25%, less than high school education 17%), having insurance (private 24%, uninsured 13%), and visual impairment (mild 31%, none 22%). Older age, female sex, higher educational attainment, having insurance, and presence of visual impairment were also significantly associated with higher mean eye care expenditure. In those with eye care expenditure, the mean ratio between eye care and total medical expenditure was 24%, with uninsured patients spending 42% of their medical care expenditure on eye care. CONCLUSIONS Demographic factors are associated with both the probability of having ocular expenditure and the amount of expenditure. Of all factors examined, insurance status has the most potential for modification. Policy makers should consider these numbers when devising the terms by which eye care coverage will be provided under the Patient Protection and Affordable Care Act.
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Affiliation(s)
- Anat Galor
- Miami Veterans Affairs Medical Center , Miami, FL , USA
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McCollister KE, Scott CK, Dennis ML, Freitas DM, French MT, Funk RR. Economic Costs of a Postrelease Intervention for Incarcerated Female Substance Abusers: Recovery Management Checkups for Women Offenders (RMC-WO). J Offender Rehabil 2014; 53:543-561. [PMID: 27030790 PMCID: PMC4809613 DOI: 10.1080/10509674.2014.944739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study estimates the economic costs of Recovery Management Checkups for Women Offenders (RMC-WO), highlighting the unique mix of services and differential costs between two distinct phases of the intervention. Participants were randomly assigned to quarterly outcome monitoring (OM) only (n=242) or OM plus Recovery Management Checkups (OM-plus-RMC) (n=238). The OM-only condition has a total annual economic cost of $76,010, which equates to $81 quarterly per person. The average cost per OM interview completed is $86. OM-plus-RMC generates a total annual economic cost of $126,717, or $137 quarterly per person. The cost per interview completed is $147 and the cost per intervention session completed is $161. RMC-WO has a relatively modest additional cost compared with the average costs of post-release supervision, which can range from $3.42 ($1,250) per day (year) for probationers to $7.47 ($2,750) per day (year) for parolees. The clinical, economic, and policy implications of incorporating RMC-WO into existing corrections and/or community-based treatment settings are discussed.
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Affiliation(s)
| | | | | | | | - Michael T. French
- University of Miami, Miller School of Medicine, Miami, FL 33136, USA
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Tolbert DV, McCollister KE, LeBlanc WG, Lee DJ, Fleming LE, Muennig P. The economic burden of disease by industry: Differences in quality-adjusted life years and associated costs. Am J Ind Med 2014; 57:757-63. [PMID: 24954889 DOI: 10.1002/ajim.22322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study compares differences in quality-adjusted life expectancy across the eight original National Occupational Research Agenda (NORA) industry sectors. METHODS Data from the 1997 to 2012 National Health Interview Survey (NHIS) were used to estimate quality-adjusted life years (QALYs) for all workers and by NORA sector. Differences in QALYs were calculated and translated into economic values using estimates of the societal willingness-to-pay per QALY. RESULTS Mean QALYs across workers was 29.17 years. Among NORA sectors, wholesale, and retail trade workers had the highest average QALYs remaining (35.88), while mining workers had the lowest QALYs (31.4). The economic value of this difference ranges from $604,843 to $1,155,287 per worker depending on the societal willingness-to-pay per QALY. CONCLUSION The value of life lost within some industries is very high relative to others. Additional investments in occupational safety, benefits, and health promotion initiatives may reduce these losses, but experimental research is needed to assess the effectiveness of such programs.
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McCollister KE, French MT, Freitas DM, Dennis ML, Scott CK, Funk RR. Cost-effectiveness analysis of Recovery Management Checkups (RMC) for adults with chronic substance use disorders: evidence from a 4-year randomized trial. Addiction 2013; 108:2166-74. [PMID: 23961833 PMCID: PMC3834076 DOI: 10.1111/add.12335] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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] [Received: 01/10/2013] [Revised: 03/26/2013] [Accepted: 08/08/2013] [Indexed: 11/27/2022]
Abstract
AIMS This study performs the first cost-effectiveness analysis (CEA) of Recovery Management Checkups (RMC) for adults with chronic substance use disorders. DESIGN Cost-effectiveness analysis of a randomized clinical trial of RMC. Participants were assigned randomly to a control condition of outcome monitoring (OM-only) or the experimental condition OM-plus-RMC, with quarterly follow-up for 4 years. SETTING Participants were recruited from the largest central intake unit for substance abuse treatment in Chicago, Illinois, USA. PARTICIPANTS A total of 446 participants who were 38 years old on average, 54% male, and predominantly African American (85%). MEASUREMENTS Data on the quarterly cost per participant come from a previous study of OM and RMC intervention costs. Effectiveness is measured as the number of days of abstinence and number of substance use-related problems. FINDINGS Over the 4-year trial, OM-plus-RMC cost on average $2184 more than OM-only (P < 0.01). Participants in OM-plus-RMC averaged 1026 days abstinent and had 89 substance use-related problems. OM-only averaged 932 days abstinent and reported 126 substance use-related problems. Mean differences for both effectiveness measures were statistically significant (P < 0.01). The incremental cost-effectiveness ratio for OM-plus-RMC was $23.38 per day abstinent and $59.51 per reduced substance-related problem. When additional costs to society were factored into the analysis, OM-plus-RMC was less costly and more effective than OM-only. CONCLUSIONS Recovery Management Checkups are a cost-effective and potentially cost-saving strategy for promoting abstinence and reducing substance use-related problems among chronic substance users.
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Affiliation(s)
- Kathryn E. McCollister
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
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McCollister KE, Freitas DM, Prado G, Pantin H. Opportunity costs and financial incentives for Hispanic youth participating in a family-based HIV and substance use preventive intervention. J Prim Prev 2013; 35:13-20. [PMID: 24162106 DOI: 10.1007/s10935-013-0330-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper presents results from a pilot study of the synergies between the opportunity costs incurred by research participants, participant compensation, and program attendance in a family-based substance use and HIV preventive intervention for Hispanic adolescents in Miami-Dade County, Florida. To estimate parent/caretaker cost per session and cost for the duration of the intervention, we administered the Caretaker Drug Abuse Treatment Cost Analysis Program to a random sample of 34 families who participated in a recent clinical trial of Familias Unidas. The total opportunity cost per parent/caretaker was under $40 per group session, under $30 per family session, and just over $570 for the duration of the intervention. Participants were compensated between $40 and $50 per session and attended more than 79% of family and group sessions. Parents and caretakers incurred a cost of approximately $30-40 per intervention session for which they were adequately compensated. Attendance was very good overall for this group (>79%) and significantly higher than attendance in a comparable uncompensated study group from another recent Familias Unidas trial that targeted similar youth. Findings suggest that incentives should be considered important for future implementations of Familias Unidas and similar family-based interventions that target minority and low-SES populations.
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Affiliation(s)
- Kathryn E McCollister
- Department of Public Health Sciences (R669), University of Miami Miller School of Medicine, Clinical Research Building, Room 1043, 1120 NW 14th Street, Miami, FL, 33136, USA,
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Galor A, Zheng DD, Arheart KL, Lam BL, Perez VL, McCollister KE, Ocasio M, McClure LA, Lee DJ. Dry eye medication use and expenditures: data from the medical expenditure panel survey 2001 to 2006. Cornea 2012; 31:1403-7. [PMID: 22895158 PMCID: PMC11015531 DOI: 10.1097/ico.0b013e31823cc0b7] [Citation(s) in RCA: 29] [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: 11/26/2022]
Abstract
PURPOSE To study dry eye medication use and expenditures from 2001 to 2006 using a nationally representative sample of US adults. METHODS This study retrospectively analyzed dry eye medication use and expenditures of participants of the 2001 to 2006 Medical Expenditure Panel Survey, a nationally representative subsample of the National Health Interview Survey. After adjusting for survey design and for inflation using the 2009 inflation index, data from 147 unique participants aged 18 years or older using the prescription medications Restasis and Blephamide were analyzed. The main outcome measures were dry eye medication use and expenditures from 2001 to 2006. RESULTS Dry eye medication use and expenditures increased between the years 2001 and 2006, with the mean expenditure per patient per year being $55 in 2001 to 2002 (n=29), $137 in 2003 to 2004 (n=32), and $299 in 2005 to 2006 (n=86). This finding was strongly driven by the introduction of topical cyclosporine emulsion 0.05% (Restasis; Allergan, Irvine, CA). In analysis pooled over all survey years, demographic factors associated with dry eye medication expenditures included gender (female: $244 vs. male: $122, P<0.0001), ethnicity (non-Hispanic: $228 vs. Hispanic: $106, P<0.0001), and education (greater than high school: $250 vs. less than high school: $100, P<0.0001). CONCLUSIONS We found a pattern of increasing dry eye medication use and expenditures from 2001 to 2006. Predictors of higher dry eye medication expenditures included female gender, non-Hispanic ethnicity, and greater than a high school education.
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Affiliation(s)
- Anat Galor
- Division of Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL 33132, USA.
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McCollister KE. Cost-effectiveness analysis of recovery management checkups: Continuing care for adults with substance use disorders. J Subst Abuse Treat 2012. [DOI: 10.1016/j.jsat.2012.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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McCollister KE, Zheng DD, Fernandez CA, Lee DJ, Lam BL, Arheart KL, Galor A, Ocasio M, Muennig P. Racial disparities in quality-adjusted life-years associated with diabetes and visual impairment. Diabetes Care 2012; 35:1692-4. [PMID: 22751960 PMCID: PMC3402250 DOI: 10.2337/dc11-2433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Compare differences in health-related quality of life among blacks and whites to examine if race, diabetes, and visual impairment (VI) present a triple disadvantage in terms of quality-adjusted life expectancy. RESEARCH DESIGN AND METHODS Data were analyzed from the 2000-2003 Medical Expenditure Panel Survey, a nationally representative survey that contains the EuroQol 5D (EQ-5D). The EQ-5D generates health utility values that provide a measure of the morbidity associated with various health states, such as having moderate or severe problems with mobility. The EQ-5D score can be linked with life expectancy data to calculate quality-adjusted life-years (QALYs), the number of years of optimal health an individual is expected to live. Multivariate analyses were conducted to estimate and compare differences in QALYs by diabetes status, VI status, and race. RESULTS Whites had a higher quality-adjusted life expectancy across all diabetes/VI comparisons. Overall, blacks with diabetes and VI had the fewest number of QALYs remaining (19.6 years), and whites with no impairment had the greatest number of QALYs remaining (31.6 years). Blacks with diabetes only had 1.7 fewer years of optimal health (fewer QALYs) than whites with diabetes. Within individuals with both diabetes and VI, however, this gap more than doubled, with blacks experiencing 3.5 fewer QALYs than whites. CONCLUSIONS Although efforts to target and reduce racial health disparities associated with diabetes appear to be effective, black communities may be contributing to a greater overall burden of illness given poorer infrastructure and less accommodation for disabilities such as VI.
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Affiliation(s)
- Kathryn E McCollister
- Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Alexandre PK, Beulaygue IC, French MT, McCollister KE, Popovici I, Sayed BA. The economic cost of substance abuse treatment in the state of Florida. Eval Rev 2012; 36:167-185. [PMID: 22710081 DOI: 10.1177/0193841x12450164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Public and private stakeholders of substance abuse treatment services require economic cost data to guide program evaluations and funding decisions. BACKGROUND Rigorous cost assessments have been conducted for several treatment programs across the United States, but a systematic and comprehensive evaluation of programs in a particular state has never been attempted. RESEARCH DESIGN The present study recruited all publicly funded treatment programs in the State of Florida and administered the Brief Drug Abuse Treatment Cost Analysis Program. SUBJECTS A total of 175 programs participated in the study, representing a 71% response rate. MEASURES Annual, weekly, and episode costs are estimated by modality. CONCLUSION The study procedures and empirical findings from this research can be used by program evaluators and government officials in Florida and other states as they develop service reimbursement algorithms and initiate more extensive evaluations of publicly funded substance abuse treatment programs.
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Affiliation(s)
- Pierre K Alexandre
- Health Economics Research Group, University of Miami, Coral Gables, FL 33124, USA
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Caban-Martinez AJ, Davila EP, McCollister KE, Fleming LE, Zheng DD, Lam BL, Dubovy SR, Lee DJ. Age-related macular degeneration and smoking cessation advice by eye care providers: a pilot study. Prev Chronic Dis 2011; 8:A147. [PMID: 22005640 PMCID: PMC3221586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Smoking is a modifiable risk factor for age-related macular degeneration (AMD), the leading cause of irreversible vision loss in the United States. We conducted a pilot study among eye care providers and AMD patients to assess smoking cessation preferences and cessation services offered at a large academic medical center. Most patients who smoke reported never being advised to quit smoking, although most eye care providers reported that they had advised smokers to quit. Two-thirds of providers expressed a desire for additional training and resources to support patient quit attempts, indicating the need for the integration of smoking cessation opportunities in the clinic setting.
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Affiliation(s)
- Alberto J. Caban-Martinez
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Clinical Research Building
| | - Evelyn P. Davila
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, Florida
| | - Kathryn E. McCollister
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, Florida
| | - Lora E. Fleming
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, Florida
| | - Diane D. Zheng
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, Florida
| | - Byron L. Lam
- Department of Ophthalmology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Sander R. Dubovy
- Department of Ophthalmology, University of Miami, Miller School of Medicine, Miami, Florida
| | - David J. Lee
- Department of Epidemiology and Public Health and Department of Ophthalmology, University of Miami, Miller School of Medicine, Miami, Florida
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Arheart KL, Fleming LE, Lee DJ, Leblanc WG, Caban-Martinez AJ, Ocasio MA, McCollister KE, Christ SL, Clarke T, Kachan D, Davila EP, Fernandez CA. Occupational vs. industry sector classification of the US workforce: which approach is more strongly associated with worker health outcomes? Am J Ind Med 2011; 54:748-57. [PMID: 21671459 PMCID: PMC3168588 DOI: 10.1002/ajim.20973] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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] [Accepted: 04/27/2011] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Through use of a nationally representative database, we examined the variability in both self-rated health and overall mortality risk within occupations across the National Occupational Research Agenda (NORA) Industry Sectors, as well as between the occupations within the NORA Industry sectors. METHODS Using multiple waves of the National Health Interview Survey (NHIS) representing an estimated 119,343,749 US workers per year from 1986 to 2004, age-adjusted self-rated health and overall mortality rates were examined by occupation and by NORA Industry Sector. RESULTS There was considerable variability in the prevalence rate of age-adjusted self-rated poor/fair health and overall mortality rates for all US workers. The variability was greatest when examining these data by the Industry Sectors. In addition, we identified an overall pattern of increased poor/fair self-reported health and increased mortality rates concentrated among particular occupations and particular Industry Sectors. CONCLUSIONS This study suggests that using occupational categories within and across Industry Sectors would improve the characterization of the health status and health disparities of many subpopulations of workers within these Industry Sectors.
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Affiliation(s)
- Kristopher L Arheart
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Florida, USA
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Lam BL, Zheng DD, Davila EP, Arheart KL, Ocasio MA, McCollister KE, Caban-Martinez AJ, Lee DJ. Trends in glaucoma medication expenditure: Medical Expenditure Panel Survey 2001-2006. Arch Ophthalmol 2011; 129:1345-50. [PMID: 21670329 PMCID: PMC11017788 DOI: 10.1001/archophthalmol.2011.142] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To study trends of glaucoma medication expenditure from 2001 to 2006 using a nationally representative sample of US adults. METHODS We analyzed glaucoma medication expenditure trends among participants of the 2001-2006 Medical Expenditure Panel Survey, a subsample of the National Health Interview Survey, which is a continuous multipurpose, multistage area probability survey of the US civilian noninstitutionalized population. After adjusting for survey design and inflation using the 2009 inflation index, data from 1404 participants 18 years and older using glaucoma medication were analyzed. RESULTS Mean annual glaucoma medication expenditure per subject increased from $445 in 2001 to $557 in 2006 (slope = 20.8; P < .001). Subgroup analysis showed expenditure increased significantly in women (P = .02), those with public-only insurance (P < .001), and those with less than a high school education (P < .008). Over the survey period, a significant decrease in expenditures on β-blockers (P = .048) and significant increases in expenditures on prostaglandin analogs (P = .01) and α-agonists (P = .01) were found. CONCLUSIONS Factors associated with increasing glaucoma medication expenditure trends include the increasing use of prostaglandin analogs, changes in insurance coverage, and possibly more aggressive glaucoma treatment. The findings are pertinent to the development of cost-effective strategies that optimize treatment and reduce expenditures.
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Affiliation(s)
- Byron L Lam
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL 33136, USA.
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Caban-Martinez AJ, Lee DJ, Fleming LE, Tancredi DJ, Arheart KL, LeBlanc WG, McCollister KE, Christ SL, Louie GH, Muennig PA. Arthritis, occupational class, and the aging US workforce. Am J Public Health 2011; 101:1729-34. [PMID: 21778483 DOI: 10.2105/ajph.2011.300173] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The working poor sometimes delay retirement to survive. However, their higher risk of disease and disability threatens both their financial survival and their ability to work through the retirement years. We used the burden of disease attributable to arthritis by occupational class to illustrate the challenges faced by the older poor. METHODS We merged data from the National Health Interview Survey, Medical Expenditure Panel Survey, and the National Death Index into a single database. We then calculated and compared age- and occupational class-specific quality-adjusted life years (QALYs) between workers with and without arthritis by using unabridged life tables. RESULTS White-collar workers have a higher overall health-related quality of life than do other workers, and suffer fewer QALYs lost to arthritis at all ages. For instance, whereas 65-year-old white-collar workers without arthritis look forward to 17 QALYs of future life, blue-collar workers with arthritis experience only 11, and are much less likely to remain in the workforce than are those in service, farming, or white-collar jobs. CONCLUSIONS To meet the needs of the aging workforce, more extensive health and disability insurance will be needed.
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Affiliation(s)
- Alberto J Caban-Martinez
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, FL 33136, USA.
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Dy CJ, McCollister KE, Lubarsky DA, Lane JM. An economic evaluation of a systems-based strategy to expedite surgical treatment of hip fractures. J Bone Joint Surg Am 2011; 93:1326-34. [PMID: 21792499 DOI: 10.2106/jbjs.i.01132] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [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: 02/06/2023]
Abstract
BACKGROUND A recent systematic review has indicated that mortality within the first year after hip fracture repair increases significantly if the time from hospital admission to surgery exceeds forty-eight hours. Further investigation has shown that avoidable, systems-based factors contribute substantially to delay in surgery. In this study, an economic evaluation was conducted to determine the cost-effectiveness of a hypothetical scenario in which resources are allocated to expedite surgery so that it is performed within forty-eight hours after admission. METHODS We created a decision tree to tabulate incremental cost and quality-adjusted life years in order to evaluate the cost-effectiveness of two potential strategies. Several factors, including personnel cost, patient volume, percentage of patients receiving surgical treatment within forty-eight hours, and mortality associated with delayed surgery, were considered. One strategy focused solely on expediting preoperative evaluation by employing personnel to conduct the necessary diagnostic tests and a hospitalist physician to conduct the medical evaluation outside of regular hours. The second strategy added an on-call team (nurse, surgical technologist, and anesthesiologist) to staff an operating room outside of regular hours. RESULTS The evaluation-focused strategy was cost-effective, with an incremental cost-effectiveness ratio of $2318 per quality-adjusted life year, and became cost-saving (a dominant therapeutic approach) if =93% of patients underwent expedited surgery, the hourly cost of retaining a diagnostic technologist on call was <$20.80, or <15% of the hospitalist's salary was funded by the strategy. The second strategy, which added an on-call surgical team, was also cost-effective, with an incremental cost-effectiveness ratio of $43,153 per quality-adjusted life year. Sensitivity analysis revealed that this strategy remained cost-effective if the odds ratio of one-year mortality associated with delayed surgery was >1.28, =88% of patients underwent early surgery, or =339.9 patients with a hip fracture were treated annually. CONCLUSIONS The results of our study suggest that systems-based solutions to minimize operative delay, such as a dedicated on-call support team, can be cost-effective. Additionally, an evaluation-focused intervention can be cost-saving, depending on its success rate and associated personnel cost.
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Affiliation(s)
- Christopher J Dy
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Dietz NA, Lee DJ, Fleming LE, Leblanc WG, McCollister KE, Arheart KL, Davila EP, Caban-Martinez AJ. Trends in smokeless tobacco use in the us workforce: 1987-2005. Tob Induc Dis 2011; 9:6. [PMID: 21631951 PMCID: PMC3118314 DOI: 10.1186/1617-9625-9-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 06/01/2011] [Indexed: 01/28/2023] Open
Abstract
The primary aim was to examine whether increasing workplace smoking restrictions have led to an increase in smokeless tobacco use among US workers. Smokeless tobacco exposure increases the risk of oral cavity, esophageal, and pancreatic cancers, and stroke. The prevalence of smokeless tobacco use decreased from 1987-2000, except among men 25-44. While smokeless tobacco use has declined in the general population, it may be that the prevalence of smokeless tobacco use has increased among workers due to workplace smoking restrictions, which have been shown to have increased over the years. Using the most current nationally representative National Health Interview Survey (NHIS) data, we examined whether increasing workplace smoking restrictions have led to an increase in smokeless tobacco use among US workers (n = 125,838). There were no significant changes in smokeless tobacco use prevalence from 1987-2005 (pooled prevalence = 3.53%); rates also were lower in smoke free workplaces. Worker groups with high rates of smokeless tobacco use included farm workers (10.51%) and blue collar workers (7.26%). Results indicate that smokeless tobacco prevention strategies targeting particular worker groups are warranted.
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Affiliation(s)
- Noella A Dietz
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Department of Epidemiology & Public Health, 1120 NW 14 Street, 15 Floor C202, Miami, Florida 33136, USA.
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Dennis ML, French MT, McCollister KE, Scott CK. The economic costs of quarterly monitoring and recovery management checkups for adults with chronic substance use disorders. J Subst Abuse Treat 2011; 41:201-7. [PMID: 21466944 DOI: 10.1016/j.jsat.2011.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 01/25/2011] [Accepted: 02/11/2011] [Indexed: 11/15/2022]
Abstract
Recovery management checkups (RMCs) for clients with substance use disorders reduce the time from relapse to treatment reentry, increase treatment retention, and improve long-term outcomes. The objectives of this article are to calculate and compare the economic costs of providing outcome monitoring (OM) only with those of providing OM + RMC to help understand the feasibility of disseminating this model more widely. We estimate the total and incremental costs of OM and OM + RMC using data from a recently completed randomized controlled trial with adult chronic substance users (N = 446). Adding RMC to OM increased total intervention costs by about 50% per person per year ($707 to $1,283) and quarter ($177 to $321). It cost an average of $834 to identify a person in relapse and $2,699 to identify, link, and retain them in treatment. The increased costs of RMC are modest relative to the substantial societal costs of chronic substance users returning to regular use, crime, and other risk behaviors.
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Davila EP, Florez H, Fleming LE, Lee DJ, Goodman E, LeBlanc WG, Caban-Martinez AJ, Arheart KL, McCollister KE, Christ SL, Clark JC, Clarke T. Prevalence of the metabolic syndrome among U.S. workers. Diabetes Care 2010; 33:2390-5. [PMID: 20585004 PMCID: PMC2963500 DOI: 10.2337/dc10-0681] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Differences in the prevalence of cardiovascular disease (CVD) and its risk factors among occupational groups have been found in several studies. Certain types of workers (such as shift workers) may have a greater risk for metabolic syndrome, a precursor of CVD. The objective of this study was to assess the differences in prevalence and risk of metabolic syndrome among occupational groups using nationally representative data of U.S. workers. RESEARCH DESIGN AND METHODS Data from 8,457 employed participants (representing 131 million U.S. adults) of the 1999-2004 National Health and Nutrition Examination Survey were used. Unadjusted and age-adjusted prevalence and simple and multiple logistic regression analyses were conducted, adjusting for several potential confounders (BMI, alcohol drinking, smoking, physical activity, and sociodemographic characteristics) and survey design. RESULTS Of the workers, 20% met the criteria for the metabolic syndrome, with "miscellaneous food preparation and food service workers" and "farm operators, managers, and supervisors" having the greatest age-adjusted prevalence (29.6-31.1%) and "writers, artists, entertainers, and athletes," and "engineers, architects, scientists" the lowest (8.5-9.2%). In logistic regression analyses "transportation/material moving" workers had significantly greater odds of meeting the criteria for metabolic syndrome relative to "executive, administrative, managerial" professionals (odds ratio 1.70 [95% CI 1.49-2.52]). CONCLUSIONS There is variability in the prevalence of metabolic syndrome by occupational status, with "transportation/material moving" workers at greatest risk for metabolic syndrome. Workplace health promotion programs addressing risk factors for metabolic syndrome that target workers in occupations with the greatest odds may be an efficient way to reach at-risk populations.
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Affiliation(s)
- Evelyn P Davila
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, Florida, USA.
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Davila EP, Christ SL, Caban-Martinez AJ, Lee DJ, Arheart KL, LeBlanc WG, McCollister KE, Clarke T, Zimmerman F, Goodman E, Muntaner C, Fleming LE. Young adults, mortality, and employment. J Occup Environ Med 2010; 52:501-4. [PMID: 20431416 PMCID: PMC4139005 DOI: 10.1097/jom.0b013e3181d5e371] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study assessed the relationship between employment status and mortality over a 2-year period among a nationally representative sample of young adults aged 18 to 24 years (n = 121,478, representing more than 21 million US young adults). METHODS By using data from the 1986-2000 National Health Interview Survey and its public-use mortality follow-up through 2002, mortality after 2-year follow-up (for each individual) was regressed on employment status at baseline, controlling for gender, race, education, season, and survey design. RESULTS Having been employed was associated with significantly lower risks of all-cause, homicide, and "other-cause" mortality (adjusted odds ratios range: 0.51 to 0.60). CONCLUSION Working appears to be a factor that may prevent premature mortality among young adults; increasing unemployment may result in increased mortality risks among young adults in the future.
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Affiliation(s)
- Evelyn P Davila
- Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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McCollister KE, French MT, Fang H. The cost of crime to society: new crime-specific estimates for policy and program evaluation. Drug Alcohol Depend 2010; 108:98-109. [PMID: 20071107 PMCID: PMC2835847 DOI: 10.1016/j.drugalcdep.2009.12.002] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [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] [Received: 03/10/2009] [Revised: 11/30/2009] [Accepted: 12/02/2009] [Indexed: 10/20/2022]
Abstract
Estimating the cost to society of individual crimes is essential to the economic evaluation of many social programs, such as substance abuse treatment and community policing. A review of the crime-costing literature reveals multiple sources, including published articles and government reports, which collectively represent the alternative approaches for estimating the economic losses associated with criminal activity. Many of these sources are based upon data that are more than 10 years old, indicating a need for updated figures. This study presents a comprehensive methodology for calculating the cost to society of various criminal acts. Tangible and intangible losses are estimated using the most current data available. The selected approach, which incorporates both the cost-of-illness and the jury compensation methods, yields cost estimates for more than a dozen major crime categories, including several categories not found in previous studies. Updated crime cost estimates can help government agencies and other organizations execute more prudent policy evaluations, particularly benefit-cost analyses of substance abuse treatment or other interventions that reduce crime.
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Affiliation(s)
- Kathryn E. McCollister
- Assistant Professor of Health Economics, Department of Epidemiology and Public Health (R669), University of Miami Miller School of Medicine, Clinical Research Building, Room 1051, 1120 NW 14th Street, Miami, Florida, 33136, USA
| | - Michael T. French
- Professor of Health Economics, Department of Sociology, Department of Epidemiology and Public Health, and Department of Economics, University of Miami, 5202 University Drive, Merrick Building, Room 121F, P.O. Box 248162, Coral Gables, FL 33124-2030, USA
| | - Hai Fang
- Assistant Professor, Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Denver, 13001 E 17th Place, Campus Box B119, Aurora, CO 80045, USA
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Caban-Martinez AJ, Lee DJ, Davila EP, LeBlanc WG, Arheart KL, McCollister KE, Christ SL, Clarke T, Fleming LE. Sustained low influenza vaccination rates in US healthcare workers. Prev Med 2010; 50:210-2. [PMID: 20079761 PMCID: PMC2839028 DOI: 10.1016/j.ypmed.2010.01.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [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] [Received: 09/30/2009] [Revised: 01/02/2010] [Accepted: 01/07/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A substantial morbidity and mortality burden attributable to the influenza virus is observed annually in the United States. Healthcare workers are an occupational group at increased risk of exposure, demonstrated to transmit influenza to their patient populations, and vital to the care of these patient populations. The prevention of the spread of the flu is a significant public health concern. In the present study, we examined influenza vaccination rates and their 5-year trends within the major occupational healthcare worker groups and compared them to non-Healthcare Workers. METHODS Using data from the nationally representative 2004-2008 National Health Interview Survey (NHIS), US healthcare workers (n=6349) were analyzed. RESULTS Seasonal influenza vaccination coverage estimates remain low among all healthcare workers, highest among the health diagnosing and treating practitioners (52.3%), and lowest among other healthcare support occupations (32.0%). Among all other occupational groups, pooled influenza vaccination rates were highest for white collar workers (24.7%), and lowest for farm workers (11.7%). There were no significant upward or downward trends in influenza vaccination rates for any healthcare or other occupational worker group during the 5-year survey period. CONCLUSION Improving these low vaccination rates among healthcare workers warrants a comprehensive national approach to influenza prevention that includes education and strong encouragement of routine annual vaccination among healthcare workers. Policy enhancements such as free provision of seasonal influenza vaccine, coverage for treatment and workers compensation for vaccine-related complications are needed.
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Affiliation(s)
- Alberto J Caban-Martinez
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
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McCollister KE, Arheart KL, Lee DJ, Fleming LE, Davila EP, LeBlanc WG, Christ SL, Caban-Martinez AJ, West JP, Clark JE, Erard MJ. Declining health insurance access among US Hispanic workers: not all jobs are created equal. Am J Ind Med 2010; 53:163-70. [PMID: 19565629 DOI: 10.1002/ajim.20720] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 11/06/2022]
Abstract
INTRODUCTION Approximately 18% of the U.S. population are uninsured, a proportion that may continue to rise, particularly among Hispanics, as the cost of medical care increases faster than the growth in wages. METHODS Health insurance trends were analyzed by race-ethnic category, and among Hispanic workers by occupation type and industrial sector, using data on employed respondents > or =18 years from 1997 to 2007 National Health Interview Survey (NHIS) (mean annual n = 17,392, representing 123 million US workers on average over this 11 year period). RESULTS From 1997 to 2007, the relative decline in health insurance coverage for US workers was greatest among Hispanics (7.0%). Hispanic workers in the Construction and Services industries had the greatest overall decline in coverage (24.9% and 14.7%), as well as Hispanic blue collar workers (14.0%). CONCLUSION Hispanic workers in general, and those employed in blue collar, construction, and services sectors in particular, are at greater risk for poor access to health care due to a lack of health insurance coverage.
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Affiliation(s)
- Kathryn E McCollister
- Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer, Miami, Florida 33136, USA.
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Lewis JE, Arheart KL, LeBlanc WG, Fleming LE, Lee DJ, Davila EP, Cabán-Martinez AJ, Dietz NA, McCollister KE, Bandiera FC, Clark JD. Food label use and awareness of nutritional information and recommendations among persons with chronic disease. Am J Clin Nutr 2009; 90:1351-7. [PMID: 19776144 PMCID: PMC3151015 DOI: 10.3945/ajcn.2009.27684] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [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] [Received: 02/26/2009] [Accepted: 08/19/2009] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Because of the relation between chronic disease and poor nutritional habits, the use of food labels and adherence to dietary recommendations are important for chronic disease populations. We explored whether persons with chronic disease read nutrient information on food labels and whether they were aware of dietary guidelines. OBJECTIVE This study aimed to assess dietary information use among persons with chronic disease by using a nationally representative sample of the US population. DESIGN A total of 5603 respondents aged > or =17 y from the 2005-2006 National Health and Nutrition Examination Survey participated in the study. This representative sample of US civilians were asked 17 questions regarding their awareness of federal nutrition information and their food label use and were given two 24-h recall dietary interviews. Participants were classified into 5 disease categories: 1) hypertension, 2) hypercholesterolemia, 3) diabetes/at risk of diabetes, 4) overweight, and 5) heart disease. RESULTS Subjects with chronic diseases were more aware of nutritional recommendations, checked more often for specific nutrients, and used nutrition information on food labels more often than did participants without such diseases. Label use behavior was inconsistently associated with dietary guideline compliance. CONCLUSIONS People with chronic disease generally reported better nutrition awareness and food label use and checking behaviors compared with those without chronic disease, but this did not translate into unequivocally better eating behaviors. New strategies are needed to improve the actual nutritional behaviors of persons with chronic disease.
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Affiliation(s)
- John E Lewis
- Department of Psychiatry and Behavioral Sciences and Epidemiologyr and Public Health, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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McCollister KE, French MT, Pyne JM, Booth B, Rapp R, Carr C. The cost of treating addiction from the client's perspective: results from a multi-modality application of the Client DATCAP. Drug Alcohol Depend 2009; 104:241-8. [PMID: 19574000 PMCID: PMC2737263 DOI: 10.1016/j.drugalcdep.2009.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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: 12/11/2008] [Revised: 05/10/2009] [Accepted: 05/11/2009] [Indexed: 10/20/2022]
Abstract
There is a considerable disparity between the number of individuals who need substance abuse treatment and the number who actually receive it. This is partly due to the fact that many individuals with substance use disorders do not perceive a need for formal treatment. Another contributing factor, however, is a discrepancy between the real and perceived cost of services. Although many cost evaluations of substance abuse treatment have been conducted from the treatment provider perspective, less is known about the client-specific costs of attending treatment (e.g., lost work and leisure time, transportation, out-of-pocket and in-kind payments). Concerns about financial and other barriers to participating in treatment have encouraged addiction researchers to more carefully consider these previously unmeasured costs. To address this information gap, we administered the Client Drug Abuse Treatment Cost Analysis Program (Client DATCAP) to 302 clients (representing a total of 302 outpatient and 142 inpatient treatment episodes) as part of a larger study examining the cost-effectiveness of interventions designed to improve treatment linkage and engagement in Dayton, Ohio. The value of a client's time accounted for the largest component of total cost (more than 59%). The cost per visit for outpatient clients ranged from $19 for outpatient methadone to $38 for intensive outpatient/aftercare treatment. The average cost per day of treatment for inpatient clients was $235. Policy makers and treatment providers now have a broader view of the opportunity cost of addiction treatment and can use this information to support initiatives for improved treatment access and delivery.
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Affiliation(s)
- Kathryn E McCollister
- Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Clinical Research Building, Room 1051 (R-669), Miami, FL 33136, USA.
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Davila EP, Caban-Martinez AJ, Muennig P, Lee DJ, Fleming LE, Ferraro KF, LeBlanc WG, Lam BL, Arheart KL, McCollister KE, Zheng D, Christ SL. Sensory impairment among older US workers. Am J Public Health 2009; 99:1378-85. [PMID: 19542042 DOI: 10.2105/ajph.2008.141630] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We used 1997-2004 National Health Interview Survey data to evaluate the prevalence of sensory impairment among US workers 65 years and older. Hearing impairment prevalence was 3 times that of visual impairment (33.4% vs 10.2%), and 38% of older workers reported experiencing either impairment. Farm operators, mechanics, and motor vehicle operators had the highest prevalence of sensory impairment. Workplace screening and accommodations, including sensory protection devices for older workers, are warranted given the greater risk for injuries among the sensory impaired.
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Affiliation(s)
- Evelyn P Davila
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Lee DJ, Arheart KL, Lam BL, Zheng D, Christ SL, McCollister KE, Davila EP, Caban-Martinez AJ. Trends in reported visual impairment in United States adults. Ophthalmic Epidemiol 2009; 16:42-9. [PMID: 19191181 DOI: 10.1080/09286580802624434] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The purpose of this study was to assess if rates of reported visual impairment (VI) in the United States (US) are declining. The 1997-2005 National Health Interview Survey is an annual probability survey of US households (n = 289,442 adults 18 years of age and older). Participants responding yes to either question were classified as visually impaired: 1) "Do you have any trouble seeing, even when wearing glasses or contact lenses?" 2) "Are you blind or unable to see at all?" Prevalence rates were adjusted for survey design; weighted linear regression models were used to examine VI trends. Annual rates of any VI ranged from 8.6% to 10.0% with a non-significant annual downward trend of -0.04%. Significant downward trends were noted in adults who reported an eye care provider contact in the previous 12 months (-0.18%; [standard error = 0.08], p = 0.047), adults with diabetes (-0.81%; [standard error = 0.30], p = 0.01) and adults 80 years of age and older (-0.46% [0.19]; p = 0.021). Pooled analyses with adjustment for sociodemographic and diabetes status suggested that reductions in VI tended to occur in adults with eye care provider contacts. Downward trends in reported VI in older adults may be due to improvements in the treatment of ocular disease, increased eye care utilization in those with VI, or both. These findings require verification in population-based studies with clinical acuity measures in order to specifically assess the effect of eye care utilization on VI prevalence trends.
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Affiliation(s)
- David J Lee
- Department of Epidemiology and Public Health, The University of Miami Miller School of Medicine, Miami, FL 33136, USA
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