Abstract
Background:
To address the opioid use disorder (OUD) public health crisis, the ADvancing Pharmacological Treatments for OUD (ADaPT-OUD) external facilitation randomized trial was conducted in 8 intervention and 27 matched control low-performing Veterans Health Administration (VHA) facilities to increase the prescribing of medications for OUD (MOUD). Facilities were considered low-performers if they were in the bottom quartile of the facility ratio of Veterans with OUD who received MOUD. The objective of this analysis was to evaluate the healthcare expenditures of Veterans with OUD who received care in ADaPT-OUD intervention facilities compared to those receiving care in matched control facilities.
Methods:
Difference-in-differences (DID) design was used to compare the overall, outpatient, and inpatient expenditures (extracted from the VHA data warehouse) of Veterans diagnosed with OUD or receiving MOUD between the 2 groups 12 months before and after the intervention.
Results:
A total of 7348 Veterans with a diagnosis of OUD or prescribed MOUD on at least 1 encounter 12 months after ADaPT-OUD intervention at all sites (92.39% male and 83.26% white) were included for analysis. ADaPT-OUD intervention did not have a substantial impact on overall healthcare costs. However, we reported 4% fewer total encounters in the intervention sites (DID, 95% confidence intervals [CI]: 0.96 [0.92-1.00]) compared to the control sites, driven by a decline in non-VA services. Notably, the outpatient psychiatric-related costs were $391 (95% CI: $49-$733) higher per Veteran within the year after the intervention sites received external facilitation compared to control sites.
Conclusions:
Veterans at intervention sites with an OUD history had higher outpatient psychiatric-related costs, which could be explained by increased access to optimal mental health services at VHA. Improving access to OUD treatment at VA may lead to more coordinated and comprehensive treatment of both OUD and other associated mental health and physical comorbidities.
Keywords
Get full access to this article
View all access options for this article.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
