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Business Case vs. Cost Effectiveness

Business Case vs. Cost Effectiveness. Business Case for Change Current Process Operational Cost Additional Revenues Cost Effectiveness of MAT Comparative Societal Impact. Assessing the Process. Questions What is the current process? Who is involved in each process step?

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Business Case vs. Cost Effectiveness

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  1. Business Case vs. Cost Effectiveness • Business Case for Change • Current Process • Operational Cost • Additional Revenues • Cost Effectiveness of MAT • Comparative • Societal Impact

  2. Assessing the Process • Questions • What is the current process? • Who is involved in each process step? • What is the time associated with each process step (T)? • What is the average hourly salary per staff involved (S) ? • What are the material costs associated with each process step (M)? Process Cost = N = Number of Steps in the Process J = Number of Staff involved in the Process

  3. Measuring the Impact of Change • Admissions • What rate do you receive for a successful admission? • What was the average number of admissions prior to the change? • What was the average number of admissions after the change? • What is the average number of sessions per admission? • Continuation • What is the average individual session rate? • What is the average group session rate? • What is the average number of sessions per admission? • How many are individual sessions? • How many are group sessions?

  4. Example Costs http://www.registerednursern.com/registered-nurse-rn-salary-pay-wages-and-income-of-registered-nurses http://www.indeed.com/salary?q1=Nurse+Practitioner&l1=19120 1. RN = $31.29/hr vs. NP = $42.31 vs. Psychiatric NP = $27.88 (All for PA or Philadelphia Area) + 40% Fringe

  5. Recent Studies

  6. ORIGINAL REPORT Advancing Recovery: Implementing Evidence-Based Treatment for Substance Use Disorders at the Systems LevelMay 2012 Journal of Studies on Alcohol and Drugs www.jsad.com Laura A. Schmidt PhD,1 Traci Rieckmann PhD,2 Amanda Abraham, PhD3, Todd Molfenter PhD4, Victor Capoccia PhD4 Paul Roman PhD,3 David H. Gustafson PhD4, Dennis McCarty PhD2 1 University of California – San Francisco, San Francisco, CA2 Oregon Health and Sciences University, Portland, OR 3 University of Georgia, Athens, GA4 University of Wisconsin, Madison, WI Funding : This study was funded through a grant from the Robert Wood Johnson Foundation.

  7. Changes in Medication Access

  8. Conclusions • Implementation needs to be flexible to address the various demands of specific treatment modalities and existing systems. • Successful systems change occurs not because of a solitary “top-down” or “bottom-up” change process but through a coordinated effort between policymakers and providers. • Change is not clean or linear. • Simultaneous implementation of change. • Continual back-and-forth of policy revision and real-world implementation. • Multiple inputs are required to promote sustainable changes in the treatment for alcohol and other drug problems.

  9. ORIGINAL REPORT Extended-Release Naltrexone for Alcohol Dependence: Persistence and Healthcare Costs and UtilizationJune 2011 American Journal of Managed Care www.ajmc.com William C. Bryson MD MPH, John McConnell PhD, P Todd Korthius MD MPH and Dennis McCarty PhD This study was completed without external funding. Aetna Behavioral Healthcare provided the data. Dr Korthuis’ time was supported by NIDA K23DA019809. From the Oregon Health and Sciences University. Alkermes funded the publication of this Am J Managed Care Supplement.

  10. Average Cost per Patient, Over 6 Months $1,000 $0 -$1,000 -$3,000 -$5,000 Cost Per Patient XR-NTX XR-NTX XR-NTX XR-NTX vs. vs. vs. vs. Oral NTX Acamprosate Disulfiram Psychosocial Tx

  11. Utilization: Post- vs. Pre-Treatment Change 4 2 0 -2 -4 Psychiatrist & Therapist Visits Outpatient Behav’l Health Facility Visits Inpatient Admissions Inpatient Days ED Visits Avg. Utilization Per Patient(Visits, Admits, or Days) XR-NTX XR-NTX XR-NTX XR-NTX vs. vs. vs. vs. Oral NTX Acamprosate Disulfiram Psychosocial Tx

  12. Conclusions • Patients given XR-NTX persisted with treatment longer than those on oral meds or psychosocial therapy only. • XR-NTX patients had the lowest inpatient & ER costs. • XR-NTX patients had the lowest utilization vs. oral meds.

  13. ORIGINAL REPORT Alcohol Dependence Treatments: ComprehensiveHealthcare Costs, Utilization Outcomes,and Pharmacotherapy PersistenceJune 2011 American Journal of Managed Care www.ajmc.com Onur Baser PhD,1 Mady Chalk PhD,2 Richard A. Rawson PhD,3 David R. Gastfriend MD4 1 STATInMED Research, Inc., and University of Michigan, Ann Arbor, MI 2 Treatment Research Institute, Philadelphia, PA 3 UCLA, Los Angeles CA4 Alkermes, Inc., Waltham, MA Funding : This study was funded through a contract from Alkermes, Inc. to Ingenix Pharmaceutical Services Inc. and STATinMED Research, Inc. Author Disclosures: Dr. Gastfriend is an employee of Alkermes Inc. and reports owning stock in the company.

  14. Any vs. No Medication:TOTAL Cost per patient (inpatient + outpatient + pharmacy costs)Propensity Score Matched Outcomes for 6 Months After Index Date * * Any vs. No Medication: P<0.0001

  15. Any vs. No Medication: Inpatient Admissions (per 1000 patients)Propensity Score Matched Outcomes for 6 Months After Index Date * Any vs. No Medication: P<0.0001 * * *

  16. TOTAL Cost per patient (inpatient + outpatient + pharmacy costs): Propensity Score Matched Outcomes 6 Months After Index Date ǂ P-value vs. XR-NTX: ǂ P<0.001

  17. Cost Drivers – Inpatient Admissions (per 1000 patients): Propensity Score Matched Outcomes 6 Months After Index Date ǂ ǂ ǂ ǂ * P-value vs. XR-NTX: * P<0.01; ǂ P<0.001 ǂ ǂ ǂ *

  18. Conclusions • Largest study of alcoholism treatments & costs to date • Medication treatment for alcohol dependence (vs. no med) was associated with significantly lower total healthcare costs • Cost drivers that were lower with medication treatment: • Inpatient detox/rehab admissions (were fewer on medication) • Alcoholism- or non-alcoholism-related hospitalizations(were fewer on medication) • Total healthcare costs • No difference between XR-NTX, oral NTX, and disulfiram • Significantly lower for XR-NTX vs. acamprosate • Cost drivers with XR-NTX treatment(vs. oral NTX, acamprosate & disulfiram): • Longer persistence on therapy • Fewer inpatient admissions

  19. ORIGINAL REPORT Cost and Utilization Outcomes of Opioid-Dependence TreatmentsJune 2011 American Journal of Managed Care www.ajmc.com Onur Baser PhD,1 Mady Chalk PhD,2 David A. Fielin MD,3 David R. Gastfriend MD4 1 STATInMED Research, Inc., and University of Michigan, Ann Arbor, MI 2 Treatment Research Institute, Philadelphia, PA 3 Yale University Medical School, New Haven, CT4 Alkermes, Inc., Waltham, MA Funding : This study was funded through a contract from Alkermes, Inc. to Ingenix Pharmaceutical Services Inc. and STATinMED Research, Inc. Author Disclosures: Dr Gastfriend is an employee of Alkermes Inc. and reports owning stock in the company.

  20. Any vs. No Medication:TOTAL Cost per patient (inpatient + outpatient + pharmacy costs)Propensity Score Matched Outcomes for 6 Months After Index Date * * Any vs. No Medication: P<0.0001

  21. Any vs. No Medication: Inpatient Admissions (per 1000 patients)Propensity Score Matched Outcomes for 6 Months After Index Date * Any vs. No Medication: P<0.0001 * * *

  22. TOTAL Cost per patient (inpatient + outpatient + pharmacy costs): Instrumental Variable Matched Outcomes 6-Mos After Index Date ǂ P-value vs. XR-NTX: ǂ P<0.001

  23. Inpatient Admissions (per 1000 patients): Instrumental Variable Matched Outcomes 6-Mos After Index Date ǂ P-value vs. XR-NTX: * P<0.05; †<0.01; ǂ P<0.001 † * † * †

  24. Conclusions • First real-world cost study of all opioid dependence medications • Total healthcare costs • No statistical difference for XR-NTX vs. NTX-PO or BUP • Significantly lower for XR-NTX vs. methadone • XR-NTX: fewer inpatient admits vs. NTX-PO, BUP, methadone

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