Economic Evaluation of the START Hospital Addiction Consultation Service

Overview

The START intervention significantly increased the initiation of FDA-approved medications for opioid use disorder (MOUD) during hospitalization and improved linkage to follow-up care post-discharge compared to usual care. The economic evaluation demonstrated that START is cost-effective, with an incremental cost-effectiveness ratio (ICER) of $15,750 per quality-adjusted life year (QALY).

Background

Opioid use disorder (OUD) is a critical public health issue in the US, affecting millions and contributing to a high mortality rate. Despite the availability of effective medications for OUD, their use remains low, particularly in hospitalized patients. Implementing addiction consultation services like START during hospitalization presents an opportunity to enhance MOUD initiation and improve patient outcomes.

Data Highlights

Key Findings

• The START intervention more than doubled in-hospital MOUD initiation rates compared to usual care.
• Linkage to OUD-focused follow-up care was significantly higher in the START group.
• The economic evaluation indicated that START is cost-effective from both health sector and societal perspectives.
• The incremental cost of implementing START was $162 per patient.
• The ICER for START was calculated at $15,750 per QALY gained.

Clinical Implications

Healthcare providers should consider implementing addiction consultation services like START in hospital settings to improve MOUD initiation and post-discharge care. The cost-effectiveness of such programs supports their integration into standard practice for managing opioid use disorder.

Conclusion

The START intervention demonstrates a viable approach to enhance the treatment of opioid use disorder in hospitalized patients, with significant implications for both clinical outcomes and healthcare costs.

Related Resources & Content

1. Ober et al, JAMA Internal Medicine, 2023 -- Hospital Addiction Consultation Service and Opioid Use Disorder Treatment: The START Randomized Clinical Trial
2. Management of Opioid Use Disorder | Guidelines | JAMA | JAMA Network, 2023 -- Major trial data support hospital addiction consultation services.
3. Open Forum Infectious Diseases — Evaluating the Impact of Integrated Infectious Disease Screening and Management within an Inpatient Program for Substance Use Disorders
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7. Evaluating the Impact of Integrated Infectious Disease Screening and Management within an Inpatient Program for Substance Use Disorders
8. Economic Evaluation of Various Hepatitis C Diagnosis and Treatment Strategies for Treatment-Naive Individuals Who Inject Drugs in Australia: A Model-Based Analysis
9. Management of Opioid Use Disorder | Guidelines | JAMA | JAMA Network
10. Hospital Addiction Consultation Service and Opioid Use Disorder Treatment: The START Randomized Clinical Trial | Substance Use and Addiction Medicine | JAMA Internal Medicine | JAMA Network
11. Retention and dropout from sublingual and extended-release buprenorphine treatment: A comparative analysis of data from a nationally representative sample of commercially-insured people with opioid use disorder in the United States - ScienceDirect