The cost of concordance with opiate substitution treatment guidelines

Barnett, Paul G.; Trafton, Jodie A.; Humphreys, Keith

doi:10.1016/j.jsat.2010.05.012

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Volume 39, Issue 2 , Pages 141-149, September 2010

The cost of concordance with opiate substitution treatment guidelines

Paul G. Barnett, Ph.D.
- VA Health Economics Resource Center (HERC), VA Palo Alto Health Care System, CA 94025, USA
- Center for Health Care Evaluation, VA Palo Alto Health Care System, CA 94025, USA
- Department of Health Research & Policy, Stanford University School of Medicine, Stanford, CA 94305, USA
- Corresponding author. Health Economics Resource Center, VA Palo Alto Health Care System (152), Menlo Park, CA 94025, USA. Tel.: +1 650 493 5000x2 2475; fax: +1 650 617 2639.
Jodie A. Trafton, Ph.D.
- Center for Health Care Evaluation, VA Palo Alto Health Care System, CA 94025, USA
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA 94305, USA
Keith Humphreys, Ph.D.
- Center for Health Care Evaluation, VA Palo Alto Health Care System, CA 94025, USA
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA 94305, USA

Received 28 October 2009; received in revised form 17 March 2010; accepted 3 May 2010. published online 05 July 2010.

Abstract

The Multisite Opiate Substitution Treatment study compared four opioid substitution programs that were highly concordant with clinical practice guidelines to four programs that were less concordant. Program staff were surveyed, and consenting new patients from highly concordant (n = 164) and less-concordant programs (n = 91) were assessed. After 12 months, treatment of new clients of highly staffed, guideline concordant sites cost $10,252, which is significantly more than the $6,476 cost at less-concordant programs (p < .01). Clients at highly concordant sites received significantly more group visits (M = 37.0 vs. 13.1, p < .01) but fewer dosing visits. There were no significant differences in medical care costs. Opioid substitution therapy was effective at reducing heroin use, especially at sites that were highly concordant with treatment guidelines. Annual mortality was 3.0% and did not differ by type of care. Preference-based quality of life significantly improved only at highly concordant sites.

Keywords: MOST study, Opioid substitution program, Concordance, Cost