Staffing Resource Use: A Cost Impact Model for the Utilization and Implementation of Medications for Opioid Use Disorder Within US Jails And Prisons
Author(s)
Chris D. Poole, BSc, PhD1, Courtney E. Flynn, MPH2, Stephen Chaplin, BSc1, Joris Van Stiphout, MSc1, Rashad Carlton, PharmD, MHP1, Meghan Thompson, PharmD, MHP2, Jessica Jay, PharmD2, William Mullen, PA-C, MPH2;
1Cencora, Conshohocken, PA, USA, 2Indivior, North Chesterfield, VA, USA
1Cencora, Conshohocken, PA, USA, 2Indivior, North Chesterfield, VA, USA
OBJECTIVES: Medications for opioid use disorder (MOUD) are not widely available within United States (US) carceral settings despite the high prevalence of opioid use disorder (OUD). A major barrier is resource costs, particularly staff time to administer/monitor daily dosing of MOUD. Buprenorphine extended-release (BUP-XR), administered monthly, provides an opportunity to reduce staff time needed for medication administration. The purpose of this study is to assess staff time and costs associated with administering different forms of MOUD within carceral settings.
METHODS: A cost impact model was developed to simulate staff time needed to administer MOUD (methadone, oral buprenorphine, BUP-XR [weekly/monthly injectables], and extended-release naltrexone) within carceral settings. Information on clinician and security officers’ time and responsibilities was compiled using expert opinion, targeted and systematic literature reviews, prescribing information, and timestamps from administration videos of MOUD. Clinical aspects and security officer’s time to escort and supervise incarcerated individuals to and from treatment were incorporated based on resources and assumptions. Time spent on additional steps intended to minimize the possibility of drug diversion with methadone and oral buprenorphine was considered. Total staffing cost was calculated using a micro-costing approach and the 2023 US Bureau of Labor Statistics national mean wages of licensed practical nurses and security officers.
RESULTS: Base case scenarios were run to examine the impact on staffing time needed to treat incarcerated individuals with MOUD, with modifiable inputs for the number of incarcerated individuals and duration of treatment. Total clinician and security officer staffing hours and cost savings were calculated on a per month basis by MOUD type. A one-way sensitivity analysis is planned to identify the biggest drivers of net staff time and costs.
CONCLUSIONS: OUD poses a significant burden to carceral systems. Staffing time and costs related to daily medication administration and observation can be reduced with BUP-XR.
METHODS: A cost impact model was developed to simulate staff time needed to administer MOUD (methadone, oral buprenorphine, BUP-XR [weekly/monthly injectables], and extended-release naltrexone) within carceral settings. Information on clinician and security officers’ time and responsibilities was compiled using expert opinion, targeted and systematic literature reviews, prescribing information, and timestamps from administration videos of MOUD. Clinical aspects and security officer’s time to escort and supervise incarcerated individuals to and from treatment were incorporated based on resources and assumptions. Time spent on additional steps intended to minimize the possibility of drug diversion with methadone and oral buprenorphine was considered. Total staffing cost was calculated using a micro-costing approach and the 2023 US Bureau of Labor Statistics national mean wages of licensed practical nurses and security officers.
RESULTS: Base case scenarios were run to examine the impact on staffing time needed to treat incarcerated individuals with MOUD, with modifiable inputs for the number of incarcerated individuals and duration of treatment. Total clinician and security officer staffing hours and cost savings were calculated on a per month basis by MOUD type. A one-way sensitivity analysis is planned to identify the biggest drivers of net staff time and costs.
CONCLUSIONS: OUD poses a significant burden to carceral systems. Staffing time and costs related to daily medication administration and observation can be reduced with BUP-XR.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
MSR6
Topic
Methodological & Statistical Research
Disease
SDC: Mental Health (including addition)