The cost of integrated HIV care and buprenorphine/naloxone treatment: Results of a cross-site evaluation

Bruce R. Schackman, Jared A. Leff, Michael Botsko, David A. Fiellin, Fredrick L. Altice, Philip (Todd) Korthuis, Nancy Sohler, Linda Weiss, James E. Egan, Julie Netherland, Jonathan Gass, Ruth Finkelstein

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17 Scopus citations

Abstract

Background: Implementing integrated HIV and buprenorphine/naloxone treatment requires cost estimates to plan and obtain funding. Methods: We identified costs incurred at HIV clinical sites participating in a cross-site evaluation of integrated care that followed patients for 1 year. Costs include labor, overhead, and urine toxicology analyses (clinic perspective), buprenorphine/naloxone (payer perspective) and patient time and transportation (patient perspective). Sites provided resource utilization quarterly, and providers estimated time required for each activity. With site as the unit of analysis, results are reported as median (range) of average site costs in 2008 US dollars. Results: The median number of monthly provider encounters for integrated care patients was 3.2 (1.5-13.3) compared with 1.7 (1.1-4.2) for similar patients not in integrated care, but integrated care patients had fewer physician encounters. Median monthly clinic costs per integrated care patient were $136 ($67-$677) for labor and overhead and $8 ($2-$23) for toxicology analyses, $22 higher than clinic costs for patients not in integrated care. Median monthly costs for buprenorphine/naloxone were $209 ($165-$272), and monthly patient costs in integrated care were $11 ($1-$54) higher. Conclusions: Integrated HIV and buprenorphine/naloxone treatment requires different resources, including costs that are not third-party reimbursed. Implementing integrated care will require funding for training and for new staff such as buprenorphine coordinators, in addition to reimbursement for buprenorphine/naloxone. Further research is needed to identify potential cost offsets outside of the clinic setting.

Original languageEnglish (US)
JournalJournal of Acquired Immune Deficiency Syndromes
Volume56
Issue numberSUPPL. 1
DOIs
Publication statusPublished - Mar 1 2011
Externally publishedYes

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Keywords

  • buprenorphine/naloxone
  • cost
  • HIV
  • integrated care
  • opioid dependency
  • substance abuse

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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