Transcript PowerPoint

Business Case vs. Cost
Effectiveness
• Business Case for Change
• Current Process
• Operational Cost
• Additional Revenues
• Cost Effectiveness of MAT
• Comparative
• Societal Impact
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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 = i1 1 S  T   M 
n
j
N = Number of Steps in the Process
J = Number of Staff involved in the Process

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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?
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Example Costs
Billed
Allowable/
Co-Pay
Time
Staff Cost1
New Office Visit
$159
$75.30
$7.53
20 Min
$12.88 to $19.54
Office Visit
Established
$122
$48.80
$4.88
15 Min
$9.76 to $14.81
Injection
$179
$71.60
$7.16
5 Min
$3.25 to $4.94
Service
Counseling Session
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
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Recent Studies
Study
Purpose
Other Information
Schmidt et al, 2012
Implementation of evidence-based 10 States and 2 County
treatment
Systems
Bryson et al, 2011
Healthcare costs & utilization of
Extended-Release Naltrexone for
Alcohol Dependence
As compared to Disulfiram,
Oral NTX, Acamprosate or
Psychosocial therapy only
Baser et al, 2011
Healthcare cost, utilization and
pharmacotherapy persistence in a
large health plan
As compared to Disulfiram,
Oral NTX, & Acamprosate
Baser et al, 2011
Healthcare cost and utilization of
Opioid-dependent treatment
Compared to Oral NTX,
Buprenorphine and
Methadone
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ORIGINAL REPORT
Advancing Recovery: Implementing EvidenceBased Treatment for Substance Use Disorders at
the Systems Level
May 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, CA
2 Oregon Health and Sciences University, Portland, OR
3 University of Georgia, Athens, GA
4 University of Wisconsin, Madison, WI
Funding : This study was funded through a grant from the Robert Wood Johnson Foundation.
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Changes in Medication Access
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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.
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ORIGINAL REPORT
Extended-Release Naltrexone for Alcohol Dependence:
Persistence and Healthcare Costs and Utilization
June 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.
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Average Cost per Patient, Over 6 Months
$1,000
Cost Per Patient
$0
-$1,000
-$3,000
-$5,000
XR-NTX
vs.
Oral NTX
XR-NTX
vs.
Acamprosate
XR-NTX
vs.
Disulfiram
XR-NTX
vs.
Psychosocial Tx
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Utilization: Post- vs. Pre-Treatment Change
Avg. Utilization Per Patient
(Visits, Admits, or Days)
4
Psychiatrist & Therapist Visits
Outpatient Behav’l Health Facility Visits
Inpatient Admissions
Inpatient Days
ED Visits
2
0
-2
-4
XR-NTX
vs.
Oral NTX
XR-NTX
vs.
Acamprosate
XR-NTX
vs.
Disulfiram
XR-NTX
vs.
Psychosocial Tx
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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.
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ORIGINAL REPORT
Alcohol Dependence Treatments: Comprehensive
Healthcare Costs, Utilization Outcomes,
and Pharmacotherapy Persistence
June 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 CA
4 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.
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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
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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
*
*
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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
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Cost Drivers – Inpatient Admissions (per 1000 patients):
Propensity Score Matched Outcomes 6 Months After Index Date
ǂ
ǂ
ǂ
P-value vs. XR-NTX:
ǂ
* P<0.01; ǂ P<0.001
ǂ
ǂ
*
ǂ
*
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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
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ORIGINAL REPORT
Cost and Utilization Outcomes
of Opioid-Dependence Treatments
June 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, CT
4 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.
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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
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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
*
*
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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
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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
*
†
†
*
†
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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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Acknowledgements
Support from National Institute on Drug Abuse
R01 DA029716
Integrating Addiction Treatment and Medical
Care in a Commercial Health Plan
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