Submission Type: Poster Abstract
Title: Budget Impact Tool for the Incorporation of Medications for Opioid Use Disorder into Jail/Prison Facilities
Authors: Danielle A. Ryan, MPH; Iván Montoya, MPH; Kashif Siddiqi; Edmond Hayes; Philip J. Jeng, MS; Kathryn McCollister, PhD; Sean M. Murphy, PhD
Background:
Given the personal and public consequences of untreated/undertreated OUD among persons involved in the justice system, an increasing number of jails and prisons are incorporating medication opioid use disorder (MOUD) into their system. Estimating the costs of implementing and sustaining a particular MOUD program is vital to detention facilities, who typically face modest, fixed healthcare budgets. We developed a customizable budget impact tool to estimate the implementation/sustainment costs of numerous MOUD delivery models for detention facilities.
Objectives:
To describe the tool and present an application of a hypothetical MOUD model
Methods:
The tool is populated with resources required to implement/sustain various MOUD models in detention facilities. Resources were identified via micro-costing techniques alongside randomized clinical trials. The resource-costing method is used to assign values to resources. Resources/costs are categorized as (a) fixed, (b) time-dependent, and (c) variable. Implementation costs include (a), (b), and (c) over a specified timeframe. Sustainment costs include (b) and (c). The MOUD model example entails offering all three FDA-approved medications, with methadone and buprenorphine provided by vendors, and naltrexone by the detention facility.
Results:
Fixed resources/costs are incurred only once, including accreditation fees and trainings. Time-dependent resources/costs are recurring, but fixed over a given time-period; e.g., medication delivery and staff meetings. Variable resources/costs are those that are a direct function of the number of persons treated, such as the medication provided to each patient. Using nationally-representative prices, fixed/sustainment costs were estimated to be $24,107/patient, over 1 year. Annual sustainment costs were estimated to be $15,431/patient.
Conclusions:
This tool can provide practical information on the types of costs incurred by jails/prisons in the implementation and sustainment phases of an MOUD program. This information can help inform providers, payers, and other stakeholders about financial barriers in expanding access to evidence-based OUD therapy.
