 |
Online ISSN: 1099-176X Print
ISSN: 1091-4358 Copyright © 2026 ICMPE. |
 |
Comparison of Healthcare Costs by Setting of Buprenorphine Initiation
among Veterans with Opioid Use Disorder
|
Richard E. Nelson,1 Sophia Huebler,2 Adam J.
Gordon,1 Audrey L. Jones,1 Hildi Hagedorn,3 Eric Hawkins4
|
1IDEAS Center, Veterans Affairs Salt Lake City
Health Care System; & Department of Internal Medicine, |
*Correspondence to: Richard E. Nelson, PhD, 500
Foothill Blvd, Salt Lake City, UT 84148, USA.
Tel: +1-801-582-1565 x4049
E-mail: richard.nelson@utah.edu
Source of Funding: This material is the result of work supported
with resources and the use of facilities at the George E. Wahlen Department of
Veterans Affairs Medical Center, Salt Lake City, Utah. This study was supported
with funding from the Veterans Health Administration (VHA), Office of Research
and Development, Quality Enhancement Research Initiative (QUERI) (funding
mechanism HX-22-026) conducted at the Strategic Policy Evidence-Based
Evaluation Center(SALIENT) [EBP 22-109]. Infrastructure support Department of
Veterans Affairs Health System’s Informatics, Decision-Enhancement, and
Analytic Sciences (IDEAS; CIN 13-414) Center of Innovation and the Greater
Intermountain Node (GIN; NIH/NIDA 1UG1DA049444) of the National Institute on
Drug Abuse Clinical Trials Network. Dr. Jones is supported by a VA HSR&D
Career Development Award (CDA 19-233, Award No IK2HX003090). The funders had no
role in study design, data collection and analysis, decision to publish, or
preparation of the manuscript. The views expressed in this paper are those of
the authors and do not necessarily represent the position or policy of the U.S.
Department of Veterans Affairs or the United States Government.
|
|
| The Veterans Health
Administration’s Stepped Care for Opioid Use Disorder Train the Trainer
(SCOUTT) initiative expanded buprenorphine treatment for opioid use disorder
(OUD) from specialty settings into primary care, pain, and mental health
clinics. We compared healthcare costs between Veterans who initiated
buprenorphine in SCOUTT clinics vs. non-SCOUTT clinics. Using Veterans Health
Administration electronic health record and cost data, we conducted a
retrospective cohort study of 3,573 veterans with OUD who initiated buprenorphine
between 2018 and 2023. Difference-in-differences models compared quarterly
inpatient, outpatient, pharmacy, and total healthcare costs over two years
before and after treatment initiation. SCOUTT was associated with lower
inpatient and outpatient costs during the period immediately following
treatment initiation, while pharmacy costs increased modestly, consistent with
medication use. Total healthcare costs remained stable. These findings suggest that
expanding medication treatment for OUD into non-specialty settings can improve
access without increasing overall healthcare expenditures.
|
|
Methods: We conducted a retrospective cohort
analysis of electronic health record data from the Veteran Health
Administration’s Corporate Data Warehouse and Managerial Cost Accounting
system. We identified veterans diagnosed with opioid use disorder (OUD) between
2016 and 2023 who received an initial B-MOUD prescription after 09/01/2018. We
constructed a longitudinal dataset with quarterly data for patients spanning
the two years prior to and two years following the index date, defined as the
patient’s first buprenorphine prescription. Outcomes included outpatient,
inpatient, and pharmacy costs. We conducted a difference-in-difference analysis
with patient and time fixed effects comparing outcomes before and after the
index date between patients initiating buprenorphine in different settings.
Results: Our primary analytic cohort included
3,573 patients with OUD. Among these patients, 1,202 (33.6%) had an initial
B-MOUD prescription in a SCOUTT clinic. Quarterly pharmacy costs were $260
(p=0.044) higher on average for patients initiating B-MOUD in SCOUTT and
non-SCOUTT settings over the two-year follow-up period. SCOUTT was also
associated with lower inpatient, outpatient, and total costs during quarters
shortly after treatment initiation. Restricting to SCOUTT clinics only,
patients initiating B-MOUD in a MH clinic had $726 (p<0.001) greater
outpatient costs and $1,908 (p=0.002) greater inpatient costs than those
initiating B-MOUD in a PC clinic. Healthcare costs for patients initiating
B-MOUD in PC and P clinics were no different.
Discussion: Implementation strategies to
encourage prescribing of B-MOUD in PC-P-MH settings, compared to SUD specialty
clinics, promote short-term decreases in healthcare costs.
Implications for Health
Care Provision and Use: The SCOUTT initiative’s expansion of buprenorphine treatment into
primary care, pain, and mental health clinics was associated with stable total
healthcare costs, reduced inpatient and outpatient costs shortly after
initiation, and increased pharmacy spending consistent with appropriate
medication use. These results suggest that decentralizing MOUD delivery can
improve access and continuity of care without increasing overall healthcare
expenditures.
Implications for Health
Policies: Supporting
primary care and mental health clinicians to initiate and manage MOUD—through
training, team-based models, and infrastructure such as SCOUTT—represents a
scalable, efficient approach to addressing the opioid crisis within large
healthcare systems like the VA.
Implications for Future
Research: Future
research should examine treatment retention and clinical outcomes associated
with SCOUTT implementation. In addition, studies linking to non-VA care data
would paint a more complete picture of the impact of SCOUTT on total healthcare
use.
|
Received 31 October 2025; accepted 14 May 2026
Copyright © 2026 ICMPE