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Initiating Buprenorphine for Addiction, Not Just Referrals, Most Cost Effective

Many EDs refer patients for opioid addiction for additional treatment or maybe offer a brief intervention with the referral.

A new study published in the journal Addiction suggested that is not the most cost-effective treatment for patients with untreated opioid addiction who visit the ED. Instead, researchers suggest initiating buprenorphine, a medication to reduce drug cravings and withdrawal.

In an earlier analysis of this study, Yale researchers reported that patients screened for opioid addiction and receiving ED-initiated buprenorphine and a referral for ongoing treatment tended to do better over time than those getting the standard referral or brief intervention with referral.

The new analysis compares the relative cost and value of the three approaches over the 30 days following the ED visit. Included in the costs were ED care, addiction treatment, inpatient and outpatient costs, and medications. Effectiveness was defined, for purposes of the study, as engagement in addiction treatment at 30 days.

Results indicate that ED-initiated buprenorphine was the most likely to be cost-effective, with a mean cost of $1,752 compared with $1,805 for brief intervention and $1,977 for referral. Furthermore, patients receiving ED-initiated buprenorphine were nearly twice as likely to be enrolled in addiction treatment during the 30 days after the ED visit. They also used opioids for fewer days during the monthlong period.

“On average, the costs were lowest in the ED-initiated buprenorphine group,” explained author Susan Busch, PhD, professor at the Yale School of Public Health. “Those patients did not use additional health care resources, but had better outcomes.”

“We know that the opioid epidemic has devastating consequences for individuals, yet many people are not in treatment,” said Busch. “This is one high-value, effective way to get people the help they need.”

Background information in the article pointed out that in the United States, only about one in five opioid-addicted individuals received treatment in the past year.

“We were excited to learn that not only was ED-initiated buprenorphine more effective in engaging patients in treatment, but it was cost-effective,” said senior author Gail D'Onofrio, MD. “All insurance payers and healthcare systems should be interested in these results.”

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