title: The cost of integrated HIV care and buprenorphine/naloxone treatment: results of a cross-site evaluation.
abstract: BACKGROUND
  Implementing integrated HIV and buprenorphine/naloxone treatment requires cost estimates to plan and obtain funding.
  
  
  METHODS
  We identified costs incurred at HIV clinical sites participating in a cross-site evaluation of integrated care that followed patients for 1 year. Costs include labor, overhead, and urine toxicology analyses (clinic perspective), buprenorphine/naloxone (payer perspective) and patient time and transportation (patient perspective). Sites provided resource utilization quarterly, and providers estimated time required for each activity. With site as the unit of analysis, results are reported as median (range) of average site costs in 2008 US dollars.
  
  
  RESULTS
  The median number of monthly provider encounters for integrated care patients was 3.2 (1.5-13.3) compared with 1.7 (1.1-4.2) for similar patients not in integrated care, but integrated care patients had fewer physician encounters. Median monthly clinic costs per integrated care patient were $136 ($67-$677) for labor and overhead and $8 ($2-$23) for toxicology analyses, $22 higher than clinic costs for patients not in integrated care. Median monthly costs for buprenorphine/naloxone were $209 ($165-$272), and monthly patient costs in integrated care were $11 ($1-$54) higher.
  
  
  CONCLUSIONS
  Integrated HIV and buprenorphine/naloxone treatment requires different resources, including costs that are not third-party reimbursed. Implementing integrated care will require funding for training and for new staff such as buprenorphine coordinators, in addition to reimbursement for buprenorphine/naloxone. Further research is needed to identify potential cost offsets outside of the clinic setting.
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, NY 10065, USA. brs2006@med.cornell.edu
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
authors.forename: Jared A
authors.initials: JA
authors.lastname: Leff
authors.forename: Michael
authors.initials: M
authors.lastname: Botsko
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Fredrick L
authors.initials: FL
authors.lastname: Altice
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.forename: Nancy
authors.initials: N
authors.lastname: Sohler
authors.forename: Linda
authors.initials: L
authors.lastname: Weiss
authors.forename: James E
authors.initials: JE
authors.lastname: Egan
authors.forename: Julie
authors.initials: J
authors.lastname: Netherland
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gass
authors.forename: Ruth
authors.initials: R
authors.lastname: Finkelstein
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D000069479:Buprenorphine, Naloxone Drug Combination; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000458:organization & administration; D015658:HIV Infections / Q000188:drug therapy*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy*
chemical_list: D019380:Anti-HIV Agents; D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine