Barnett PG (Stanford University)
Humphreys K (Stanford University)
Opioid dependence is a chronic disease that is most effectively treated with agonist therapy. We tested whether patients who enrolled at programs that comply with guidelines for agonist dose and psychosocial treatment incur less treatment costs or less total health care cost.
The VA Multi-site Opiate Substitution Treatment (MOST) study surveyed methadone programs and ranked them by their compliance with treatment guidelines. New patients from four highly concordant (n=165) and four poorly concordant programs (n=91) were enrolled. Participants were assessed with the Addiction Severity Index, satisfaction and quality of life surveys at enrollment, 6 months, and 12 months. VA utilization data and DSS cost estimates were obtained for the year before and the year after enrollment.
Entry into treatment was associated with a large decrease in substance use and an increase in health care utilization. Participants incurred an average of $10,254 in VA health care costs in the year before enrollment and $19,115 in the year after, including $8,950 in cost for agonist therapy. Individuals treated at sites that are highly concordant with guidelines had less substance use, better health status and quality of life, and better satisfaction with care. They incurred $11,141 in index treatment cost, significantly more than the $4,977 incurred by participants enrolled at less concordant sites (p < .01).
Agonist therapy is effective, especially at sites that are concordant with treatment guidelines, but guideline concordance adds to the cost of treatment. There was no evidence that entry into treatment reduces short-term medical care costs, regardless of whether or not the program was concordant with treatment guidelines.
Despite high prevalence of opiate dependence among veterans, VA offers opiate agonist therapy at just 36 sites. This therapy increases health care costs and improves outcomes. These effects are more pronounced in programs that comply with treatment guidelines.