Economic Analysis of a Low-Threshold Mobile Medical Unit Dispensing Buprenorphine for Opioid Use Disorder

OBJECTIVES: Buprenorphine is an effective medication treatment for opioid use disorder (OUD), but significant barriers prevent access to care. The University of Illinois Chicago (UIC) Community Outreach Intervention Project established a low-threshold mobile medical unit (MMU) to overcome access barriers and provide buprenorphine treatment in Chicago neighborhoods with high opioid overdose rates. This study collected the direct implementation, operation, and indirect patient costs associated with the MMU.

METHODS: We concurrently conducted three analyses to determine direct and indirect MMU costs. (1) Micro-costing using MMU administrative/purchasing records and on-site time-motion were used to determine daily and per-patient operation costs. (2) Interviews of MMU staff were used to identify resources/time invested in implementation and to validate/supplement time-motion observations. (3) Interviews of patients visiting the MMU for buprenorphine treatment were used to determine indirect costs (i.e. transportation time/cost, missed commitments, and perceived alternative treatments). We also conducted sensitivity analyses and scenario analyses of different services provided by the MMU.

RESULTS: The annual estimated costs were $10,400 for supplies, $106,200 for renting/maintaining the MMU, and 480 hours of total personnel time (including protocol writing, budgeting, and training). The average cost per-patient encounter was $108, and lasted between 7 and 25 minutes, depending on the services provided. Medication costs were the main driver of direct per-patient costs. Indirect patient costs were assessed in 30 individuals. The average mean patient transportation time to the care site was 35 minutes, most commonly by walking (41%), and 40% of individuals reported they would not seek OUD care elsewhere if the MMU was not available.

CONCLUSIONS: The cost-per-patient encounter of a MMU dispensing buprenorphine is sustainable once the program is implemented, despite significant implementation costs. The MMU successfully engaged individuals who otherwise would not seek OUD care elsewhere. These findings are useful to justify the continuation and expansion of low-threshold, buprenorphine-dispensing MMUs.