Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments

Horn, Brady P.; Crandall, Cameron; Forcehimes, Alyssa A.; French, Michael T.; Bogenschutz, Michael P.

doi:10.1016/j.jsat.2017.05.003

Cited by 23 publications

(11 citation statements)

References 41 publications

(41 reference statements)

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“…OAE Each other Newborns 1 year Healthcare NA IRR (no year) Detected cases No AABR is the CE alternative compared to OAE I.R. Iran’s National Institute of Health Research No Horn et al [ 30 ] USA Substance abuse 1. Minimal screening 2.…”

Section: Resultsmentioning

confidence: 99%

“…One common challenge was the lack of data on test accuracy. In some cases, authors had to assume the accuracy of the screening test [ 28 , 30 , 32 , 33 ]; more commonly, it was assumed that tests had the same performance regardless of prior testing [ 19 , 34 ]. This assumption is particularly important when different sequences of screening and diagnostics tests are being evaluated.…”

Section: Resultsmentioning

confidence: 99%

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Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Iragorri

Spackman

2018

Public Health Rev

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BackgroundScreening is an important part of preventive medicine. Ideally, screening tools identify patients early enough to provide treatment and avoid or reduce symptoms and other consequences, improving health outcomes of the population at a reasonable cost. Cost-effectiveness analyses combine the expected benefits and costs of interventions and can be used to assess the value of screening tools.ObjectiveThis review seeks to evaluate the latest cost-effectiveness analyses on screening tools to identify the current challenges encountered and potential methods to overcome them.MethodsA systematic literature search of EMBASE and MEDLINE identified cost-effectiveness analyses of screening tools published in 2017. Data extracted included the population, disease, screening tools, comparators, perspective, time horizon, discounting, and outcomes. Challenges and methodological suggestions were narratively synthesized.ResultsFour key categories were identified: screening pathways, pre-symptomatic disease, treatment outcomes, and non-health benefits. Not all studies included treatment outcomes; 15 studies (22%) did not include treatment following diagnosis. Quality-adjusted life years were used by 35 (51.4%) as the main outcome. Studies that undertook a societal perspective did not report non-health benefits and costs consistently. Two important challenges identified were (i) estimating the sojourn time, i.e., the time between when a patient can be identified by screening tests and when they would have been identified due to symptoms, and (ii) estimating the treatment effect and progression rates of patients identified early.ConclusionsTo capture all important costs and outcomes of a screening tool, screening pathways should be modeled including patient treatment. Also, false positive and false negative patients are likely to have important costs and consequences and should be included in the analysis. As these patients are difficult to identify in regular data sources, common treatment patterns should be used to determine how these patients are likely to be treated. It is important that assumptions are clearly indicated and that the consequences of these assumptions are tested in sensitivity analyses, particularly the assumptions of independence of consecutive tests and the level of patient and provider compliance to guidelines and sojourn times. As data is rarely available regarding the progression of undiagnosed patients, extrapolation from diagnosed patients may be necessary.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Iragorri

Spackman

2018

Public Health Rev

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“…Few studies have researched the resources necessary before SBIRT services can be delivered. Recent studies have focused on the costs incurred after SBIRT is implemented (Barbosa et al, 2016;Bray et al, 2012Bray et al, , 2014Horn et al, 2017;McCollister et al, 2017). Although the ongoing costs necessary to sustain SBIRT are also important in planning for service delivery, they differ from the one-off start-up costs that have been neglected in the SBIRT literature.…”

Section: Discussionmentioning

confidence: 99%

Start-Up Costs of SBIRT Implementation for Adolescents in Urban U.S. Federally Qualified Health Centers

Barbosa

Wedehase

Dunlap

et al. 2018

J. Stud. Alcohol Drugs

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Understanding the costs to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescent substance use in primary care settings is important for providers in planning for services and for decision makers considering dissemination and widespread implementation of SBIRT. We estimated the start-up costs of two models of SBIRT for adolescents in a multisite U.S. Federally Qualified Health Center (FQHC). In both models, screening was performed by a medical assistant, but models differed on delivery of brief intervention, with brief intervention delivered by a primary care provider in the generalist model and a behavioral health specialist in the specialist model. Method: SBIRT was implemented at seven clinics in a multisite, cluster randomized trial. SBIRT implementation costs were calculated using an activity-based costing methodology. Start-up activities were defined as (a) planning activities (e.g., changing existing electronic medical record system and tailoring service delivery protocols); and (b) initial staff training. Data collection instruments were developed to collect staff time spent in start-up activities and quantity of nonlabor resources used. Results: The estimated average costs to implement SBIRT were $5,182 for the specialist model and $3,920 for the generalist model. Planning activities had the greatest impact on costs for both models. Overall, more resources were devoted to planning and training activities in specialist sites, making the specialist model costlier to implement. Conclusions: The initial investment required to implement SBIRT should not be neglected. The level of resources necessary for initial implementation depends on the delivery model and its integration into current practice.

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“…Several studies focusing on screening, brief intervention, and referral to treatment (SBIRT) initiatives among Medicaid patients presenting to the ED for substance use disorder have estimated potential savings between $2000 to $6000 per patient year [72,73]. Many programs were implemented at a total cost of less than $100 per patient initiated in treatment [74][75][76]. A further administrative decision to incentivize clinicians to obtain the x-waiver qualification can promote interest and involvement at the clinician level.…”

Section: Implementing An Ed-based Buprenorphine Treatment Programmentioning

confidence: 99%

Approach to buprenorphine use for opioid withdrawal treatment in the emergency setting

Cisewski

Santos

Koyfman

et al. 2019

The American Journal of Emergency Medicine

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Opioid use disorder (OUD) is increasing in prevalence throughout the world, with approximately three million individuals in the United States affected. Buprenorphine is a medication designed, researched, and effectively used to assist in OUD recovery. Objective: This narrative review discusses an approach to initiating buprenorphine in the emergency department (ED) for opioid-abuse recovery. Discussion: Buprenorphine is a partial mu-opioid receptor agonist with high affinity and low intrinsic activity. Buprenorphine's long half-life, high potency, and 'ceiling effect' for both euphoric sensation and adverse effects make it an optimal treatment alternative for patients presenting to the ED with opioid withdrawal. While most commonly provided as a sublingual film or tablet, buprenorphine can also be delivered via transbuccal, transdermal, subdermal (implant), subcutaneous, and parenteral routes. Prior to ED administration, caution is recommended to avoid precipitation of buprenorphine-induced opioid withdrawal. Following the evaluation of common opioid withdrawal symptoms, a step-by-step approach to buprenorphine can by utilized to reach a sustained withdrawal relief. A multimodal medication-assisted treatment (MAT) plan involving pharmacologic treatment, as well as counseling and behavioral therapy, is essential to maintaining opioid remission. Patients may be safely discharged with safe-use counseling, close outpatient follow-up, and return precautions for continued management of their OUD. Establishing a buprenorphine program in the ED involves a multifactorial approach to establish a pro-buprenorphine culture. Conclusions: Buprenorphine is an evidence-based, safe, effective treatment option for OUD in an ED-setting. Though successfully utilized by many ED-based treatment programs, the stigma of 'replacing one opioid with another' remains a barrier. Evidence-based discussions on the safety and benefits of buprenorphine are essential to promoting a culture of acceptance and optimizing ED OUD treatment.

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Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments

Cited by 23 publications

References 41 publications

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Start-Up Costs of SBIRT Implementation for Adolescents in Urban U.S. Federally Qualified Health Centers

Approach to buprenorphine use for opioid withdrawal treatment in the emergency setting

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