Table of contents
Abstract 4
1.0 GENERAL INFORMATION 5
1.1 Purpose 5
1.2 Scope 5
1.3 Background and Overview 6
1.3.1 Overview of the problem 6
1.3.2 Rationale for the proposed solution 8
1.3.2 Ethics and Integrity 9
1.4 Project References 10
1.5 Points of Contact 11
2.0 ANALYSIS SUMMARY 12
2.1 Assumptions and Constraints 12
2.2 Methodology 13
2.3 Recommendations 13
3.0 DESCRIPTION OF ALTERNATIVES 14
3.1 Current Policy or Practice 14
3.2 Proposed Project, Policy, or Initiative 15
3.3 Alternative Policies or Initiatives 16
4.0 COSTS 18
4.1 Development Costs 18
4.2 Operational Costs 18
4.3 Nonrecurring Costs 19
4.3.1 Capital Investment Costs 19
4.3.2 Other Nonrecurring Costs 20
4.4 Recurring Costs 20
5.0 BENEFITS 21
5.1 Nonrecurring Benefits 21
5.1.1 Cost Reduction 21
5.1.2 Value Enhancement 21
5.1.3 Other 22
5.2 Recurring Benefits 22
5.3 Non-quantifiable Benefits or Non-tangible Benefits 22
6.0 COMPARATIVE COST AND BENEFIT SUMMARY 23
6.1 Conclusions and Recommendations 23
References 25
Abstract
The opioid crisis has been in existence for the past 30 years. There are many reasons why this epidemic exists. Primarily, the opioid crisis stems from the good intentions by prescribers to help improve and alleviate the pain and suffering among patients. However, this good intention has contributed to the misuse of the drugs resulting in significant morbidity and an increase in mortality rates. Prescribed opioids were originally anticipated to treat terminal and acute pain conditions. Because of the increased death rate due to opioid overdosing, government agencies have begun to evaluate how health care providers and health care facilities control pain among their patients. This paper proposes the implementation of an expanded buprenorphine-based medication-assisted treatment for patients diagnosed with opioid use disorders. A cost-benefit analysis of the policy initiative points to its potential to substantially assist in the management and prevention of the opioid epidemic. The successful implementation of the policy would require the engagement of all stakeholders including government agencies, patients, providers, and health care facilities in South Carolina.
Keywords : Cost-benefit analysis, medication-assisted treatment.
Opioid Crisis Prevention Cost-Benefit Analysis
1.0 GENERAL INFORMATION
Purpose
The purpose of the cost-benefit analysis presented in this paper is to analyze the medication-assisted treatment program for opioid use disorders to determine its value as an opioid crisis prevention strategy. Accordingly, the paper explores the potential benefits of the program as well as the costs associated with it. Such an analysis is deemed critical as the program is aimed at increasing access to medication-assisted treatment (MAT) with buprenorphine to increase the associated positive health and economic effects. When overseeing a project, rational decisions are imperative given the many variables in society. A cost-benefit analysis outlines the choice process over many other varying positions. Its importance in project implementation is that it offers a systematic method of execution and highlights the advantages and disadvantages associated with program adoption.
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1.2 Scope
The scope of this cost-benefit analysis is to present the costs and benefits of implementing a MAT program in South Carolina over the next five years. The program has been lauded to be highly effective for treating and managing opioid abuse and withdrawal (DAODAS, 2018). In fact, the Department of Alcohol and Other Drug Abuse Services (DAODAS) – the South Carolina government agency charged with ensuring quality services to prevent or reduce the negative consequences of substance use and addictions – has been increasing the state’s capacity to treat individuals with opioid use disorder and has funded thirteen treatment agencies to partner with local healthcare providers that deliver MAT for opioid use disorders (DAODAS, 2018).
1.3 Background and Overview
1.3.1 Overview of the problem
The excessive prescription of opioids has resulted in complex and appalling cases of misuse that have resulted in significant health costs, premature loss of life, and considerable economic losses. Various factors have been identified as contributors to the epidemic. One of the main precipitants of the scourge was the enlightenment of physicians in the 90s about the inadequate management of pain as well as the unprecedented boom in marketing opioids by pharmaceutical companies (Emmel, 2017) . Susceptibility to opioid use disorder has also been linked to genetics. Moreover, the availability of a purer version of heroin markedly increased the number of willing users owing to the effectiveness of the intranasal route of use (Emmel, 2017) . Addressing the opioid crisis has truly been a daunting challenge considering millions of people suffer from some sort of pain. Opioids are indicated for the management of acute pain associated with degenerative joint disease, arthritis, surgery or trauma, just to name a few. Unfortunately, the increasing trend by prescribers to readily dish out opioids can be interpreted as a misguided focus on symptomatic relief rather than treating the underlying condition or root cause of pain. The dangers of the increasing misuse of opioids and opiates have been a worldwide issue.
According to the 2017 report by the Council of Economic Advisers (CEA), the drug crisis has reached an all-time high. In 2015, over 50,000 people are said to have died from a drug overdose, of which 63 percent (33,091) reportedly involved opioids (CEA, 2017) . Even with these alarming figures, the problem is worsening rapidly as opioid-related overdose mortality rates have doubled over the last decade and have quadrupled over the last sixteen years (CEA, 2017). The seriousness of the situation has compelled the federal government to take a strong stance in combatting drug addiction by declaring a public health emergency per the Public Health Services Act (CEA, 2017). Florence et al. (2016) reported that the estimated cost in 2013 due to opioid abuse, overdose and dependence was 73.5 billion dollars. In 2019, the cost has been estimated to range from 172 billion to about 214 billion dollars (Siegel, 2019). The increased cost has been attributed to activities of the criminal justice system (incarceration), healthcare spending, and loss of productivity.
Every state has its statistics on prescription drug overdose. The Centers for Disease Control and Prevention (CDC) has a program called Prevention for States that provides funds to state health departments. Not all states receive this funding that provides resources and support such as monitoring programs, required health systems interventions, state evaluations, and rapid response to prevent drug crisis (CDC, n.d.). South Carolina is one of the states that receive this funding. The awards range from 750,000 and 1 million dollars to advance the prevention of the opioid crisis. According to the National Institute of Drug Abuse (2019), the state of South Carolina 2017 posted 749 deaths due to an opioid overdose in 2017. This is a rate of 15.5 deaths per 100,000 persons compared to the national rate of 14.6 deaths per 100,000 people (National Institute of Drug Abuse, 2019). Just like the national trend, there has been an increase in mortality associated with opioid use in The Carolina’s. The number of opioid-related overdose deaths in South Carolina by opioid category over the years is shown in Figure 1. The categories of drugs presented in the figure are not mutually exclusive since some of the deaths could have occurred due to more than one substance. The categories of drugs presented in the figure are not mutually exclusive. The occurrence of the deaths could have been as a result of more than one substance.
Figure 1: Number of opioid-related overdose deaths in South Carolina by opioid category.
The cost of opioid treatment may vary due to certain factors. Naltrexone costs $1176.50 per month which averages out to be 14,000 dollars a year, methadone costs 126.00 dollars a month that averages to 6, 500 dollars a year, and buprenorphine costs 115 dollar per week, averaging to 5, 980 dollars a year (National Institute of Drug Abuse, n.d.).
1.3.2 Rationale for the proposed solution
The proposed solution is rational since the chief goal for city and health departments is to collaborate to ensure that prevention and treatment resources are available to those affected by the opioid crisis. Two types of treatment exist in opioid dependence: pharmacological and behavioral. Pharmacological interventions modulate how the body reacts to the substance. Medication-assisted treatment for opioid use disorders with a drug such as buprenorphine is an example of a pharmacological intervention in which FDA-approved medications, in combination with counseling and behavioral therapies, are used to treat substance use disorders (SAMHSA, 2015). With the evidence supporting MAT as an effective treatment for opioid use disorder and the magnitude of the opioid crisis in South Carolina, the proposed initiative is intended to expand buprenorphine-based MAT services to individuals with the most pressing needs within geographic areas of highest need. Importantly, the initiative will prevent diversion and ensure quality services are provided.
1.3.2 Ethics and Integrity
Ethics and Integrity are two core values that foster corporation and improve performance. Existing studies suggest that through strategic planning, organizations may consider four elements that would ensure an ethical alignment with the stakeholders. Precisely, the stakeholder theory would direct any manager of a public corporation to develop a code of ethics, undertake ethical training, develop confidential reporting systems, and have situational advice to the rest of the stakeholders concerning the role of ethics to the institution's vision, strategy, and other factors. The Office of Civil Rights (OCR) discusses the problem of not being fully prepared when too much of patient private health information (PHI) is revealed in an emergent situation. Health care providers and their staff are obligated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations not to change policy and procedures during any emergencies such as the opioid crisis. As providers of health care, there is the need to sharpen awareness and double the efforts to protect a patients' rights to privacy.
There are various ways in which confidentiality may be breached and PHI disclosed unintentionally. To prevent the occurrence of such breaches, health care professionals should never discuss cases or use any identifiers that could be directly linked to a patient in the public domain. It is also imperative that healthcare professionals first establish the authority of whoever is requesting privileged patient information before disclosing it and obtain the patient’s permission through verbal or written consent which should then be documented in the patient’s chart. Patient privacy is paramount and organizations could face costly litigations and damage to their reputation in case of a breach to patient privacy. Protecting the integrity, confidentiality and the availability of a patient’s information is a multifaceted task and requires meticulous approaches to avert the negative effects that could otherwise arise.
The initiative to increase access to buprenorphine-based MAT for the management of opioid use disorders is designed in a manner that will ensure the equitable distribution of services to the diverse population in South Carolina. Expanding the scope of the program such that it takes a landscape view and focuses on service delivery through the lens of racial and social justice would be critical to enhancing the opioid crisis prevention efforts through an equitable approach to healthcare. Public health endeavors must go beyond the mere creation of awareness to the implementation of comprehensive solutions to the needs of the state on addressing the opioid crisis. This project, therefore, will enhance collaborative efforts in the prevention of the opioid crisis at all levels. It follows the recognition that no single entity has the appropriate machinery to completely address the extensive epidemic in the absence of combined efforts by stakeholders (House of Representatives South Carolina, 2018) . Accordingly, the stakeholders that would be solicited for this project will be medical professionals, law enforcement, and pain management centers. By engaging stakeholders, the public health system in South Carolina will be able to come up with strategies to implement the policy in a manner that addresses both racial and health inequities in the management of opioid use disorders.
1.4 Project References
The following are primary references were used in the preparation of this document.
Department of Health and Human Services (HHS). (2016). Medication-Assisted Treatment for Opioid Use Disorders, Final Rule. Federal Register. 42 CFR Part 8.
South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS). (2018). Budget Request. Fiscal Year 2018-2019.
1.5 Points of Contact
The following stakeholders may be contacted to respond to additional questions on the information presented in this document:
Patricia Roane Monroe – current document creator
Email: Patricia.Roane@prismahealth.org
Phone: 267- 439-3324 – document custodian of HHS Medication-Assisted Treatment for Opioid Use Disorders, Final Rule.
Jinhee Lee, Pharm.D., Public Health Advisor, Center for Substance Abuse Treatment,
Phone: 240-276-2700
2.0 ANALYSIS SUMMARY
2.1 Assumptions and Constraints
Albeit useful, a cost-benefit analysis often has various associated uncertainties and risks that are imperative to note. These uncertainties typically arise from human agendas, the employment of a heuristic approach in reaching conclusions, and the inaccuracies of the data sets used. A significant portion of the risks involved with CBA correlates to the human elements involved. Interested parties or stakeholders may attempt to influence the outcomes by understating or overstating costs. In some instances, persons in support of a project or initiative may insert organizational or personal bias into the CBA. Concerning data, there is a tendency for the analysis to overly rely on data compiled from previous initiatives. This could unconsciously lead to results that do not directly apply to the situation under consideration. In some cases, the data leveraged from earlier analyses may be directly applicable to the circumstances at hand. As a result, the outcomes may not be consistent with those of the situation under consideration. For instance, the assumptions associated with this CBA stem from the fact that the data used is based on the analysis of costs and benefits the Department of Health and Human Services (HHS) conducted to increase the provision of waivers to treat up to 275 patients with buprenorphine-based MAT. Regarding the number of practitioners who will seek a waiver to treat up to 275 patients, the number of individuals with opioid use disorders who will receive medication-assisted treatment (MAT), the average per-person health benefits associated with this new approach to treatment, and the current dollar value of these health improvements may vary (HHS, 2016). The potential constraints include a limited budget that the government of South Carolina may dedicate to the proposed initiative and the potential errors and inaccurate costs associated with the use of heuristics in assessing the dollar value of intangibles. The latter constraint could potentially invalidate findings.
2.2 Methodology
In conducting the cost-benefit analysis presented in this document, analysis of costs and benefits from HHS final rule on the use of waivers for administering buprenorphine-based MAT to additional patients was used (HHS, 2016). This informed the establishment of a framework outlining the parameters of the CBA. Subsequently, the costs and benefits of the proposed initiative were identified and categorized by intent and type. The costs and benefits were then calculated across the assumed life of the initiative and compared using aggregate information. Finally, the results were analyzed and an informed, final recommendation made.
2.3 Recommendations
Having completed the CBA, expanding buprenorphine-based MAT services were found to have more benefits than costs and would thus come a long way in helping South Carolina manage its opioid use disorder victims, thus necessitating the adoption of several recommendations. It is thus recommended that these services be expanded by increasing the maximum patient limit for qualified practitioners to receive a waiver from 100 to 275. While increasing this limit, measures should also be in place to ensure that practitioners are adequately qualified, appropriately licensed, and have the necessary resources to provide buprenorphine-based MAT services. Moreover, with the proposed expansion of the service, there should be complementary measures to reduce the trafficking and access of otherwise healthy individuals to opioids.
3.0 DESCRIPTION OF ALTERNATIVES
3.1 Current Policy or Practice
The South Carolina Department of Health and Environmental Control (DHEC) and the DAODAS have made significant steps towards the prevention of the opioid crisis in the Carolina’s. The state has various laws dedicated to the implementation of opioid prevention programs. DHEC is mandated with the administration of a prescription monitoring program that tracks the supply of controlled substances in the state. The Department also works with local, state, and federal government agencies in the identification of places within the state with the highest incidences of opioid abuse (National Institute on Drug Abuse, 2019). South Carolina is also focused on increasing community awareness as a strategy for prevention (National Institute on Drug Abuse, 2019). Various campaigns and coalitions have thus been funded to this effect. Moreover, the opioid prevention policies in the states are centered on the reduction of illicit drug trafficking and the provision of recovery and rehabilitation services to addicts.
Various relevant laws have also been reviewed and enacted. For instance, the state now allows first emergency responders to carry naloxone, a provision that did not previously exist. While there are sound policies in place, several challenges have been observed concerning implementation and enforcement. For instance, despite the existence of the prescription monitoring program, there is inadequate funding for the programmatic enhancement of the programs to more comprehensive platforms Additionally, there is poor coordination between the state and the community in the prevention of the opioid crisis. The criminal justice system, on the other hand, seemingly has some operational flaws as evidenced by the high incarceration rates and the criminalization of individuals who should have otherwise received treatment to expedite their recovery. As such, the opioid crisis remains to be a problem in the state creating an impetus for change to the state’s opioid prevention policies.
Under the Controlled Substances Act (CSA), buprenorphine is classified as a schedule III controlled substance. As such, to qualify to treat patients with the drug, the practitioner must be a qualified and validly licensed practitioner of medicine, be a registrant of the DEA, and can make referrals for apposite counseling and other ancillary services as deemed necessary. The Act also puts a cap on the number of patients that an individual practitioner may treat with buprenorphine and other FDA-approved narcotic substances at any given time. The law specifically allows practitioners to manage a maximum of thirty patients at a go according to a section in the CSA. After one year, however, practitioners are allowed to file a notice of intent indicating their intent to manage up to 100 patients at a time. However, this maximum number of patients is subject to regulation by subsidiary law. Under the directive of DAODAS, the state of South Carolina has been expanding access to MAT services through technical and financial assistance, reimbursement support, and implementation of telehealth services. Despite these efforts to expand MAT services, there have been no initiatives to allow more practitioners to use waivers in the management of the increasing number of people with opioid use disorder.
3.2 Proposed Project, Policy, or Initiative
The proposed initiative would increase the desirability of waivers for MAT services to treat more patients with opioid use disorders (HHS, 2016). Effectively, the initiative proposed to increase the maximum patient limit for qualified practitioners to receive a waiver from 100 to 275. This higher patient limit is intended to substantively increase patient capacity for providers with the requisite qualifications to prescribe buprenorphine while making certain that the waivered practitioners have the capacity to offer comprehensive treatment and services associated with MAT. Practitioners will thus be required to meet certain infrastructural requirements above those who have waivers to treat a hundred or fewer patients, to get authorization to treat up to 275 patients.
3.3 Alternative Policies or Initiatives
Various policy suggestions have been made on how to address the issue of opioid use disorder in a broad sense. It has generally been observed that while practitioners have the freedom to prescribe buprenorphine to a limited number of patients, the prescription of opioid analgesics by practitioners is not limited. Accordingly, a policy should be implemented to remove the cap on the prescription of buprenorphine or to establish a limit for opiate prescribing. It has further been suggested that providers and practitioners that habitually prescribe opioids should be required to provide treatment for persons with opioid use disorders. Furthermore, more stringent limits should be applied in the prescribing of other controlled substances including antipsychotics, anxiolytics, and antidepressants as presently, patient limits do not apply to their prescribing. Concerning opioid prescribing, CDC released a prescribing guideline for the management of chronic pain using opioids. On the other hand, SAMHSA supports a national mentoring and training program that avails free continuing medical education (CME) programs son the effective and safe utilization of opioids in the management of chronic pain as well as the management of opioid use disorder.
Another approach to improving the problem stemming from opioid use disorder would be to integrate behavioral health with primary care and implement screening programs. importantly, HHS should emphasize the use of evidence-based practices and a full continuum of care for persons with opioid use disorder. Additional strategies should be considered to motivate primary care providers to seek waivers for prescribing buprenorphine, including educational programs to clarify matters concerning Drug Enforcement Agency (DEA) audits and buprenorphine prescribing, better dissemination of study findings and data on evidence-based medicine-assisted therapy, as well as the continued engagement with stakeholders to guarantee the appropriateness and effectiveness of the legal framework. HHS could also look into working with South Carolina state entities, as well as CDC, FDA, and DEA to come up with an educational program for the public that is as targeted as it is comprehensive to bridge the knowledge gap among relevant stakeholders. South Carolina could also increase the training, resources, and the number of qualified persons to prescribe and administer buprenorphine and monitor patients for outcomes.
4.0 COSTS
4.1 Development Costs
Stakeholders, especially practitioners that may be affected by the proposed change are expected to receive the information, process it, and come up with responses. Practitioners are likely to evaluate the requirements and opportunities associated with the increased patient limit and decide whether or not pursuing the approval to treat more patients would be beneficial. It is estimated that practitioners may spend averagely half an hour pondering on the information and deliberating on the action to take. The hourly rates for physicians are average $93.74. Following the necessary adjustments to account for benefits and overhead, it is estimated that the hourly cost of a physician’s time is $187.48 (HHS, 2016). The state of South Carolina will disseminate information to about 10,000 practitioners including those with waivers to prescribe buprenorphine as well as those who will be reached through the dissemination network of the state. For this CBA, it is assumed that seventy-five percent of these practitioners will evaluate the change and accordingly, dissemination is estimated to cost $0.7 million. Channels will also be established to communicate the details of the policy change to stakeholders. The preparation and dissemination of these materials are estimated to cost about $10,000.
4.2 Operational Costs
Going by the HHS (2016) estimates, between 100 and 300 additional practitioners are expected to request approval to treat more patients in each subsequent year. Accordingly, this translates to costs in the range of $93,000 to $337,000 related to requests for increasing patient limits in the first year. Practitioners will also be required to resubmit requests for increasing patient limits every three years to maintain their waivers to treat the maximum number of patients. The waiver request form according to HHS (2016) is a three-page document that would require half an hour to complete inferring a cost of $93.74 per resubmission given the hourly rates of physicians as previously discussed. South Carolina state agencies, as well as the DEA, will also incur costs to process the applications of the additional requests for increasing patient limit. DAODAS is projected to spend $100 processing each waiver. Going by the previous estimations of between 100 and 300 additional practitioners requesting waivers each year, the agencies are likely to spend between $50,000 and $180,000 in the first year.
4.3 Nonrecurring Costs
4.3.1 Capital Investment Costs
These costs are attributed to the establishment of a qualified practice setting that favors the provision of buprenorphine-based MAT services. Practitioners will thus incur costs in institutional capacity building to enable them to cover for medical emergencies even when the practice is closed. This calls for the recruitment of additional personnel to work such shifts. Costs will also be incurred in the incorporation of behavioral health services to the primary care offered by thy physician. Importantly, some capital will be channeled towards the establishment or the expansion of health information systems including electronic health records in the facility. As a requirement, the facilities should participate in the state's prescription drug monitoring program (PDMP). Additionally, the facility should be set up in a manner to accept contractual obligations to provide services to patients. Accordingly, the practitioner in charge is expected to incur costs in establishing arrangements for accepting third-party payment schemes. The total cost of upgrading a facility to make it a qualified center for the provision of MAT services is estimated to be about $850,000.
4.3.2 Other Nonrecurring Costs
Practitioners are also expected to incur travel expenses to attend the initial training programs including seminars and workshops that will be organized to increase awareness on the new policy governing the provision of MAT services. Organizations are also likely to incur costs conducting in-house training of personnel to enhance compliance with the new policy. Such costs could stem from outsourcing experts in the new policy to facilitate the training as well as other general overheads typical of training sessions. It is estimated that an organization could spend up to $100,000 in non-recurring costs.
4.4 Recurring Costs
The projected monthly recurring costs of operating and maintaining the policy over system life are outlined in Table 1.
| Item | Cost |
| Equipment lease, rental, and in-house maintenance | $128,000 |
| Software lease, rental, and in-house maintenance | $100,000 |
| Personnel salaries and fringe benefits | $1,000,000 |
| Direct support services (intra-agency services) | $1,200,000 |
| Travel and training (CMEs) | $1,000,000 |
| Facility and space occupancy | $200,000 |
| Materials, supplies, and utilities | $50,000 |
| Contractual services | $600,000 |
| Overhead | $250,000 |
5.0 BENEFITS
Various benefits are expected to arise from the implementation of the proposed policy initiative. These benefits range from cost reduction to value enhancement, and also include non-tangible benefits.
5.1 Nonrecurring Benefits
5.1.1 Cost Reduction
The expansion of MAT services in South Carolina is expected to increase the treatment rates of patients with opioid use disorder. This increased treatment will be supported by the provisions of the Affordable Care Act (ACA) whose expanded coverage encompasses persons at high risk of developing opioid use disorders that did not have substantive access to health insurance coverage before. Moreover, parity protections and the ACA will cover the treatment of patients in a manner comparable to other surgical and medical coverages in private insurance policies. With the expansion of MAT services and health coverage to include opioid use disorders, more patients are expected to seek treatment with buprenorphine leading to an overall reduction in the costs associated with morbidity, mortality, and loss of productivity.
5.1.2 Value Enhancement
The enhanced capacity of waivered practitioners to manage patients with buprenorphine-based MAT is expected to expand opportunities for practitioners currently treating or intending to treat patients with buprenorphine. This could turn into a financial opportunity for the practitioners depending on the overheads associated with the management of additional patients. The perceived benefits of the approval to treat more patients with buprenorphine may encourage physicians to seek the waiver and improve their competencies in the provision of MAT services. This would increase the number of physicians allowed to treat the maximum number of patients in the future and will thus help to bridge the disparity in service stemming from poor doctor-patient ratios.
5.1.3 Other
Expansion of the patient limit will generally lead to an increase in the efficiency of treating patients diagnosed with opioid use disorders. The initiative will enable treating physicians to offer appropriate services per the waiver. Further, it will result in the provision of more efficient support services besides the administration and prescribing of buprenorphine-containing medicines by allowing practitioners to supervise care which may be offered by a range of other qualified medical personnel.
5.2 Recurring Benefits
The recurring benefits associated with the expansion of MAT services in South Carolina would be the savings accruing from the recovery of opioid use disorder patients who will regain functionality and productivity. The policy will also markedly reduce the costs associated with hospitalization and rehabilitation.
5.3 Non-quantifiable Benefits or Non-tangible Benefits
The primary non-quantifiable benefit that will stem from the expansion of buprenorphine-based MAT services in South Carolina will be the enhancement of the provision of evidence-based services in the management of the opioid epidemic. The use of buprenorphine in the management of opioid use disorders has been lauded widely for its efficacy. Accordingly, its adoption is projected to improve patient outcomes in various practice settings in South Carolina and thus improved the quality of life of those affected.
6.0 COMPARATIVE COST AND BENEFIT SUMMARY
According to the data presented by HHS (2016) in their CBA of a nationwide expansion of buprenorphine-based MAT services, the quantified benefits at the then value (2014), over 5 years, by a 3 percent discount rate was estimated to be $8,935 million, and the 7 percent discount rate was estimated to be $8,228 million. The quantified benefits at an annualized value, over 5 years, by a 3 percent discount rate was estimated to be $1,894 million, and the 7 percent discount rate was estimated to be $1,875 million. The quantified costs at the then value (2014), over 5 years by a 3 percent discount rate was estimated to be $1,109 million, and the 7 percent discount rate was estimated to be $1,022 million. The quantified costs at an annualized value, over 5 years, by a 3 percent discount rate was estimated to be $235 million, and the 7 percent discount rate was estimated to be $233 million. Going by these values and extrapolating them to the context of South Carolina and the present day, no much difference would be noted in the cost-effectiveness ratio.
6.1 Conclusions and Recommendations
Overall, the past three decades have been characterized by a gradual transition from the noble intent by practitioners to adequately manage pain to an epidemic of opioid misuse and abuse. The problem continues to evolve and thus brings in new complications that require attention. South Carolina has not been spared by the epidemic and it continues to incur substantive costs due to morbidity, mortality, and loss of productivity associated with opioid use disorders. One measure to address the problem is the expansion of the buprenorphine-based MAT services offered in the state by allowing practitioners a waiver to increase the number of patients they can treat. This policy initiative would be an improvement from the current policy that caps the number of opioid use disorder patients that a practitioner can treat. The CBA of the proposed policy promises a good cost-effectiveness ratio as the benefits projected to accrue from the policy outweigh the costs associated with its implementation and maintenance. Accordingly, it is highly recommended that South Carolina adopt this policy as a measure to prevent the ongoing opioid crisis.
References
CDC. (n.d.). Prevention for States. Retrieved from Centers for Disease Control and Prevention website: https://www.cdc.gov/drugoverdose/states/state_prevention.html
CEA. (2017). The underestimated cost of the opioid crisis . Retrieved from The Council of Economic Advisers website: https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf
DAODAS. (2018). Budget Request Fiscal Year 2018-2019 . Retrieved from https://www.scstatehouse.gov/CommitteeInfo/Ways&MeansHealthcareBudgetSubcommittee/January242018/2018-2019%20DAODAS%20Budget%20Request%20Information.pdf
Emmel, J. (2017). Recovery-Oriented Medication-Assisted Treatment (MAT) . Retrieved from http://scopioidsummit.org/wp-content/uploads/2017/09/MAT-for-Governors-Opioid-Summit-combined-2017.pdf
Florence, C., Zhou, C., Luo, F., & Xu, L. (2013). “The economic burden of prescription opioid
HHS. (2016). Department of Health and Human Services 42 CFR Part 8 RIN 0930-AA22 Medication-Assisted Treatment for Opioid Use Disorders . Retrieved from https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-16120.pdf
National Institute on Drug Abuse. (2019, March 29). South Carolina Opioid Summary. Retrieved September 19, 2019, from Drugabuse.gov website: https://www.drugabuse.gov/opioid-summaries-by-state/south-carolina-opioid-summary
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SAMHSA. (2015, July 21). Medication-Assisted Treatment (MAT). Retrieved from Samhsa.gov website: https://www.samhsa.gov/medication-assisted-treatment
Siegel, R. (2019, October 17). Opioid crisis cost U.S. economy at least $631 billion, study finds. The Washington Post . Retrieved from https://www.washingtonpost.com/business/2019/10/17/opioid-crisis-cost-us-economy-least-billion-study-finds/
