Initiating buprenorphine in the emergency department (ED), followed by ongoing primary care with buprenorphine, is cost-effective for patients with opioid dependence, researchers report.
“On average, even though more people in the ED-initiated treatment group were still receiving treatment at 30 days, there were no significant differences in total healthcare costs at 30 days,” Dr. Susan H. Busch from Yale School of Public Health, New Haven, Conn., told Reuters Health by email. “ED-initiated treatment led to better outcomes (i.e., more people in treatment), with no measurable differences in healthcare costs.”
Buprenorphine is one of multiple effective treatments available for opioid dependence, but only 11 percent of people who need emergency treatment related to drug or alcohol use go on to receive it at a specialty facility.
In a recent study, Dr. Busch and colleagues showed that opioid-dependent patients receiving ED-initiated buprenorphine-naloxone had better outcomes than people who received interventions that did not include immediate buprenorphine-naloxone.
Their new report, published online August 16 in Addiction, involved 329 opioid-dependent patients treated at an urban teaching hospital ED. The researchers evaluated the costs and effects of three approaches: (1) screening, brief intervention, ED-initiated treatment with buprenorphine-naloxone, and referral to primary care for 10-week follow-up (“buprenorphine”); (2) screening, brief intervention, and facilitated referral to community-based treatment services (“brief intervention”); and (3) screening and referral to treatment (“referral”).
After ED discharge, the buprenorphine group used more drug addiction-specific, office-based services, while the referral and brief-intervention groups used more resources based at addiction treatment centers. Despite these differences in use of services, total healthcare costs differed only slightly and nonsignificantly among the groups, although point estimates were lowest in the buprenorphine group.
Because outcomes were also superior in the buprenorphine group, referral and brief intervention were found to be much less cost-effective. Moreover, ED-initiated buprenorphine outperformed the other treatments at all willingness-to-pay levels.
“Getting individuals in to evidence-based treatments should be a priority for all health care stakeholders,” Dr. Busch said by email. “Yet, healthcare costs in the U.S. are high, and there is concern that some of the care provided may be low-value.”
“From our original study, we knew this treatment was effective,” she said. “We wanted to test whether it should be considered low- or high-value by insurers or others deciding whether to adopt initiation of this treatment in the emergency department if appropriate. We thought information about the relative costs of these interventions would be useful to organizations such as health insurers and emergency departments.”